Brawner Clinton A, Abdul-Nour Khaled, Lewis Barry, Schairer John R, Modi Shalini S, Kerrigan Dennis J, Ehrman Jonathan K, Keteyian Steven J
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Am J Cardiol. 2016 Apr 15;117(8):1236-41. doi: 10.1016/j.amjcard.2016.01.018. Epub 2016 Jan 28.
The purpose of this retrospective, observational study was to describe the relation between exercise workload during cardiac rehabilitation (CR), expressed as metabolic equivalents of task (METs), and prognosis among patients with coronary heart disease. We included patients with coronary heart disease who participated in CR between January 1998 and June 2007. METs were calculated from treadmill workload. Cox regression analysis was used to describe the relationship between METs and time to a composite outcome of all-cause mortality, nonfatal myocardial infarction, or heart failure hospitalization. Among 1,726 patients (36% women; median age 59 years [interquartile range, 52 to 66]), there were 467 events (27%) during a median follow-up of 5.8 years (interquartile range, 2.6 to 8.7). In analyses adjusted for age, sex, Charlson co-morbidity index, hypertension, diabetes, and CR referral diagnosis, METs were independently related to the composite outcome at CR start (Wald chi-square 43, hazard ratio 0.59 [95% confidence interval 0.51 to 0.70]) and CR end (Wald chi-square 47, hazard ratio 0.68 [95% confidence interval 0.61 to 0.76]). Patients exercising below 3.5 METs on exit from CR represent a high-risk group with 1- and 3-year event rates ≥7% and ≥18%, respectively. In conclusion, METs during CR is available at no additional cost and can be used to identify patients at increased risk for an event who may benefit from closer follow-up, extended length of stay in CR, and/or participation in other strategies aimed at maximizing adherence to secondary preventive behaviors and improving exercise capacity.
这项回顾性观察性研究的目的是描述心脏康复（CR）期间以代谢当量（METs）表示的运动负荷与冠心病患者预后之间的关系。我们纳入了1998年1月至2007年6月期间参加CR的冠心病患者。METs由跑步机负荷计算得出。采用Cox回归分析来描述METs与全因死亡率、非致命性心肌梗死或心力衰竭住院的综合结局发生时间之间的关系。在1726例患者中（36%为女性；中位年龄59岁[四分位间距，52至66岁]），在中位随访5.8年（四分位间距，2.6至8.7年）期间发生了467起事件（27%）。在对年龄、性别、Charlson合并症指数、高血压、糖尿病和CR转诊诊断进行校正的分析中，METs在CR开始时（Wald卡方值43，风险比0.59[95%置信区间0.51至0.70]）和CR结束时（Wald卡方值47，风险比0.68[95%置信区间0.61至0.76]）均与综合结局独立相关。CR结束时运动强度低于3.5 METs的患者代表高危组，其1年和3年事件发生率分别≥7%和≥18%。总之，CR期间的METs无需额外成本即可获得，可用于识别事件风险增加的患者，这些患者可能受益于更密切的随访、延长在CR中的停留时间和/或参与其他旨在最大限度地坚持二级预防行为和提高运动能力的策略。
