经皮冠状动脉介入治疗后生活方式改变对血运重建的影响。
Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization.
机构信息
Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Duke Clinical Research Institute, Durham, NC, USA.
出版信息
Biomed Res Int. 2020 Feb 14;2020:2479652. doi: 10.1155/2020/2479652. eCollection 2020.
OBJECTIVE
Whether optimal cardiovascular health metrics may reduce the risk of cardiovascular events in secondary prevention is uncertain. The study was conducted to evaluate the influence of lifestyle changes on clinical outcomes among the subjects underwent percutaneous coronary intervention (PCI).
METHODS
The study group consists of 17,099 consecutive PCI patients. We recorded data on subject lifestyle behavior changes after their procedure. Patients were categorized as ideal, intermediate, or poor CV health according to a modified Life's Simple 7 score (on body mass, smoking, physical activity, diet, cholesterol, blood pressure, and glucose). Multivariable COX regression was used to evaluate the association between CV health and revascularization event. We also tested the impact of cumulative cardiovascular health score on reoccurrence of cardiovascular event.
RESULTS
During a 3-year median follow-up, 1,583 revascularization events were identified. The observed revascularization rate was 8.0%, 9.3%, and 10.6% in the group of patients with optimal (a modified Life's Simple 7 score of 11-14), average (score = 9 or 10), or inadequate (less or equal than 8) CV health, respectively. After multivariable analysis, the adjusted hazard ratios were 0.83 (95% CI: 0.73-0.94) and 0.89 (95% CI: 0.79-0.99) for patients with optimal and average lifestyle changes comparing with the inadequate tertile ( for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93-0.98; for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93-0.98.
CONCLUSION
Ideal CV health related to lower incidence of cardiovascular events, even after the percutaneous coronary intervention. Revascularization can be reduced by lifestyle changes. The cardiovascular health metrics could be extrapolated to secondary prevention and need for further validation.
目的
尚不确定优化的心血管健康指标是否可以降低二级预防中心血管事件的风险。本研究旨在评估生活方式改变对接受经皮冠状动脉介入治疗（PCI）患者临床结局的影响。
方法
研究组纳入 17099 例连续 PCI 患者。记录患者术后生活方式改变的数据。根据改良的 Life's Simple 7 评分（体重、吸烟、身体活动、饮食、胆固醇、血压和血糖），将患者分为理想、中等或较差的 CV 健康。多变量 COX 回归用于评估 CV 健康与血运重建事件之间的关系。我们还测试了累积心血管健康评分对心血管事件再发的影响。
结果
在中位随访 3 年期间，确定了 1583 例血运重建事件。观察到的血运重建率分别为 8.0%、9.3%和 10.6%，在优化组（改良 Life's Simple 7 评分 11-14 分）、平均组（评分=9 或 10）和不足组（评分≤8）的患者中。多变量分析后，与不足三分位组相比，优化和平均生活方式改变的患者调整后的危险比分别为 0.83（95%CI：0.73-0.94）和 0.89（95%CI：0.79-0.99）（趋势检验=0.003）。此外，上述指标每增加一个单位，血运重建的风险就会降低（HR，0.96；95%置信区间，0.93-0.98；趋势检验=0.003）。此外，上述指标每增加一个单位，血运重建的风险就会降低（HR，0.96；95%置信区间，0.93-0.98；趋势检验=0.003）。
结论
与 PCI 后心血管事件发生率较低相关的理想 CV 健康。生活方式的改变可以减少血运重建。心血管健康指标可外推至二级预防，需要进一步验证。
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