基于运动的心脏康复对非阻塞性冠状动脉疾病（MINOCA）心肌梗死患者临床结局的影响。
Effect of exercise-based cardiac rehabilitation on clinical outcomes in patients with myocardial infarction in the absence of obstructive coronary artery disease (MINOCA).
作者信息
He Chao-Jie, Zhu Chun-Yan, Zhu Yu-Juan, Zou Zhuo-Xuan, Wang Shi-Jun, Zhai Chang-Lin, Hu Hui-Lin
机构信息
Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, China.
Department of Anesthesiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, China.
出版信息
Int J Cardiol. 2020 Sep 15;315:9-14. doi: 10.1016/j.ijcard.2020.05.019. Epub 2020 May 19.
BACKGROUND
Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is characterized by clinical evidence of myocardial infarction with nonobstructive coronary stenosis on angiography (stenosis < 50%). Studies on the effect that exercise-based cardiac rehabilitation (CR) has on outcomes in MINOCA patients are lacking. Therefore, the purpose of this study was to determine the effect of exercise-based CR on clinical outcomes in patients with MINOCA.
METHODS
A total of 524 participants with MINOCA were recruited in this prospective cohort study from August 2014 to October 2016 and followed for three years. We randomly divided 524 patients into an exercise-based cardiac rehabilitation group (CR+) and a control group (CR-). The CR+ group followed a home-based exercise-training program three times a week during the three years of moderate continuous training (MCT; 65%-75% of peak heart rate) on a bicycle or treadmill.
RESULTS
After one year of follow-up, the Short Form 36 (SF-36) survey showed apparent improvement in the mean physical health score in the CR+ group compared with the CR- group (P < 0.01). During the three-year follow-up, all-cause mortality occurred in 60 individuals, and major adverse cardiovascular events (MACE) happened in 136 individuals. Kaplan-Meier curves indicated a significant reduction in all-cause mortality (log-rank P < 0.05) and MACE (log-rank P < 0.01) in the CR+ group. A multivariate Cox regression analysis indicated that exercise-based CR was associated with a significant reduction in all-cause mortality (hazard ratio [HR] = 0.483; 95% confidence interval [CI], 0.279-0.818; P < 0.01) and MACE (HR = 0.574; 95% CI, 0.403-0.827; P < 0.001).
CONCLUSIONS
A long-term exercise-based CR program was associated with superior physical health and a significant reduction in all-cause mortality and MACE in patients with MINOCA.
背景
无阻塞性冠状动脉疾病的心肌梗死（MINOCA）的特征是有心肌梗死的临床证据且血管造影显示冠状动脉狭窄无阻塞（狭窄<50%）。关于基于运动的心脏康复（CR）对MINOCA患者预后影响的研究尚缺。因此，本研究的目的是确定基于运动的CR对MINOCA患者临床预后的影响。
方法
在这项前瞻性队列研究中，于2014年8月至2016年10月共招募了524例MINOCA参与者，并随访三年。我们将524例患者随机分为基于运动的心脏康复组（CR+）和对照组（CR-）。CR+组在三年期间每周三次遵循居家运动训练计划，进行中度持续训练（MCT；心率峰值的65%-75%），训练方式为骑自行车或使用跑步机。
结果
随访一年后，简明健康状况调查量表（SF-36）显示，与CR-组相比，CR+组的平均身体健康评分有明显改善（P<0.01）。在三年随访期间，60人发生全因死亡，136人发生主要不良心血管事件（MACE）。Kaplan-Meier曲线表明，CR+组的全因死亡率（对数秩检验P<0.05）和MACE（对数秩检验P<0.01）显著降低。多因素Cox回归分析表明，基于运动的CR与全因死亡率显著降低相关（风险比[HR]=0.483；95%置信区间[CI]，0.279-0.818；P<0.01）以及与MACE显著降低相关（HR=0.574；95%CI，0.403-0.827；P<0.001）。
结论
长期基于运动的CR计划与MINOCA患者更好的身体健康状况以及全因死亡率和MACE的显著降低相关。
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