1 Cardiology, Zürcher RehaZentrum Wald, Wald, Switzerland.
2 University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland.
Eur J Prev Cardiol. 2019 Jan;26(2):138-144. doi: 10.1177/2047487318807766. Epub 2018 Oct 18.
Cardiac rehabilitation after an acute myocardial infarction has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed one-year outcome of acute myocardial infarction patients according to cardiac rehabilitation referral at discharge.
Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, who were asked to give their informed consent to a telephone follow-up one year after discharge.
From 10,141 patients, 1956 refused to participate in follow-up and 302 were lost to follow-up. There were 4508 (57.2%) patients with cardiac rehabilitation referrals compared with 3375 (42.8%) without. Patients referred to cardiac rehabilitation were younger (62.4 years vs. 68.8 years), more often male (77% vs. 70%), presented more often with ST-elevation myocardial infarction (63.5% vs. 52.1%) and, apart from smoking (44.0% vs. 34.9%), they had fewer risk factors, such as dyslipidaemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients referred to cardiac rehabilitation had a lower crude one-year all-cause mortality (1.7% vs. 5.8%; p < 0.001) and lower rates of re-infarction, rehospitalization for cardiovascular disease and intervention (all p < 0.005). In a multivariable logistic regression analysis, cardiac rehabilitation was an independent predictor for lower mortality rate (odds ratio 0.65; 95% confidence interval 0.48-0.89; p = 0.007).
Although the detailed data of cardiac rehabilitation programmes and patient participation were not available for this study, our data from 7883 acute myocardial infarction patients showed a better one-year outcome for patients with cardiac rehabilitation referrals than for those without.
目前的指南将急性心肌梗死后的心脏康复列为 I 级推荐。然而，关于其对瑞士死亡率影响的数据尚不可用。因此，我们根据出院时的心脏康复推荐情况，分析了急性心肌梗死患者的一年预后。
数据来自瑞士 AMIS Plus 注册中心，包括 ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死患者，这些患者在出院后一年接受电话随访时被要求签署知情同意书。
在 10141 名患者中，1956 名拒绝参与随访，302 名失访。有 4508 名（57.2%）患者有心脏康复推荐，而 3375 名（42.8%）患者没有。接受心脏康复推荐的患者年龄更小（62.4 岁 vs. 68.8 岁），更多为男性（77% vs. 70%），更常出现 ST 段抬高型心肌梗死（63.5% vs. 52.1%），且除了吸烟（44.0% vs. 34.9%）外，血脂异常（55.0% vs. 60.1%）、高血压（55.6% vs. 65.3%）和糖尿病（16.7% vs. 21.5%）等风险因素更少。接受心脏康复推荐的患者一年全因死亡率较低（1.7% vs. 5.8%；p<0.001），且再梗死、因心血管疾病再住院和介入治疗的发生率较低（均 p<0.005）。在多变量逻辑回归分析中，心脏康复是死亡率降低的独立预测因素（优势比 0.65；95%置信区间 0.48-0.89；p=0.007）。
尽管本研究无法获得心脏康复计划的详细数据和患者参与情况，但我们对 7883 名急性心肌梗死患者的数据显示，与未接受心脏康复推荐的患者相比，接受心脏康复推荐的患者一年预后更好。
