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与经皮冠状动脉介入治疗相比,心脏康复可使冠状动脉旁路移植手术后的心理健康得到更大改善。

Cardiac rehabilitation is associated with greater improvements in psychological health following coronary artery bypass graft surgery when compared with percutaneous coronary intervention.

机构信息

Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.

Department of Surgery, Amsterdam UMC, Location VU University Medical Centre, Amsterdam 1081 HV, the Netherlands.

出版信息

Appl Physiol Nutr Metab. 2020 Dec;45(12):1339-1344. doi: 10.1139/apnm-2020-0213. Epub 2020 Jun 16.

DOI:10.1139/apnm-2020-0213
PMID:32544341
Abstract

Following coronary revascularization, patients treated with coronary artery bypass graft surgery (CABG) have lower risk of major adverse cardiovascular events when compared with those treated with percutaneous coronary intervention (PCI). We compared changes in cardiovascular risk factors, such as psychological and cardiometabolic health indicators, among patients who completed cardiac rehabilitation (CR) following CABG and PCI. Longitudinal records of 278 patients who completed an outpatient CR program following CABG or PCI were analyzed. We compared changes in anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS); health-related quality of life (HR-QoL) measured by the Medical Outcomes Study Short Form-36 (SF-36); and indicators of cardiometabolic health (i.e., body mass, blood pressure, glucose, and lipid profiles) between CABG and PCI groups using analysis of covariance (ANCOVA). At baseline, patients treated with PCI ( = 191) had superior physical function (i.e., physical functioning: 62.5 ± 22.1 vs. 54.3 ± 23.0 points, = 0.006; and role limitations due to physical health: 31.2 ± 36.8 vs. 20.6 ± 31.8 points, = 0.024) when compared with those treated with CABG ( = 87). Following CR, patients treated with PCI showed significantly smaller improvements in depression (-0.4 ± 3.1 vs. -1.3 ± 2.7 points, = 0.036) and mental HR-QoL (mental component summary: 2.4 ± 10.8 vs. 5.7 ± 10.7 points, = 0.020) when compared with those treated with CABG. Patients with coronary artery disease treated with PCI have smaller functional limitations but similar psychological health when compared with those treated with CABG at CR enrollment. Patients participating in CR following PCI appear to achieve smaller psychological health benefits from CR when compared with those recovering from CABG.

摘要

在冠状动脉血运重建后,与经皮冠状动脉介入治疗(PCI)相比,接受冠状动脉旁路移植术(CABG)治疗的患者发生主要不良心血管事件的风险较低。我们比较了完成 CABG 和 PCI 后接受心脏康复(CR)的患者的心血管危险因素变化,如心理和心脏代谢健康指标。分析了 278 例完成 CABG 或 PCI 门诊 CR 计划的患者的纵向记录。我们使用协方差分析(ANCOVA)比较了 CABG 和 PCI 组之间焦虑和抑郁的变化(通过医院焦虑和抑郁量表(HADS)评估);健康相关生活质量(通过医疗结局研究短表 36 项(SF-36)评估);以及心脏代谢健康指标(即体重、血压、血糖和血脂谱)。在基线时,与接受 CABG 治疗的患者(n=87)相比,接受 PCI 治疗的患者(n=191)具有更好的身体功能(即身体功能:62.5±22.1 分 vs. 54.3±23.0 分,P=0.006;因身体健康导致的角色限制:31.2±36.8 分 vs. 20.6±31.8 分,P=0.024)。在接受 CR 后,与接受 CABG 治疗的患者相比,接受 PCI 治疗的患者的抑郁(-0.4±3.1 分 vs. -1.3±2.7 分,P=0.036)和心理 HR-QoL(心理成分综合评分:2.4±10.8 分 vs. 5.7±10.7 分,P=0.020)的改善明显较小。与接受 CABG 治疗的患者相比,接受 PCI 治疗的冠心病患者在 CR 登记时的功能限制较小,但心理健康状况相似。与接受 CABG 康复的患者相比,接受 PCI 并参加 CR 的患者似乎从 CR 中获得的心理健康益处较小。

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