Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.
Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK.
Eur J Prev Cardiol. 2022 May 25;29(7):1074-1080. doi: 10.1093/eurjpc/zwab191.
Accumulating evidence questions the clinical value of percutaneous coronary intervention (PCI) for patients with chronic coronary syndrome (CCS). We therefore compare the impact of exercise-based cardiac rehabilitation (CR) vs. PCI in patients with CCS on 18-month mortality and morbidity, and evaluate the effects of combining PCI with exercise-based CR.
A retrospective cohort study was conducted in March 2021. An online, real-world dataset of CCS patients was acquired, utilizing TriNetX, a global federated health research network. Patients with CCS who received PCI were first compared with patients who were prescribed exercise-based CR. Second, we compared patients who received both CR + PCI vs. CR alone. For both comparisons, patients were propensity-score matched by age, sex, race, comorbidities, medications, and procedures. We ascertained 18-month incidence of all-cause mortality, rehospitalization, and cardiovascular comorbidity [stroke, acute myocardial infarction (AMI), and new-onset heart failure]. The initial cohort consisted of 18 383 CCS patients. Following propensity score matching, exercise-based CR was associated with significantly lower odds of all-cause mortality [0.37 (95% confidence interval (CI): 0.29-0.47)], rehospitalization [0.29 (95% CI: 0.27-0.32)], and cardiovascular morbidities, compared to PCI. Subsequently, patients that received both CR + PCI did not have significantly different odds for all-cause mortality [1.00 (95% CI: 0.63-1.60)], rehospitalization [1.00 (95% CI: 0.82-1.23)], AMI [1.11 (95% CI: 0.68-1.81)], and stroke [0.71 (95% CI: 0.39-1.31)], compared to CR only.
Compared to PCI, exercise-based CR associated with significantly lower odds of 18-month all-cause mortality, rehospitalization, and cardiovascular morbidity in patients with CCS, whilst combining PCI and exercise-based CR associated with lower incident heart failure only.
越来越多的证据对经皮冠状动脉介入治疗（PCI）在慢性冠状动脉综合征（CCS）患者中的临床价值提出了质疑。因此，我们比较了 CCS 患者接受基于运动的心脏康复（CR）与 PCI 的 18 个月死亡率和发病率，并评估了将 PCI 与基于运动的 CR 相结合的效果。
本研究为回顾性队列研究，于 2021 年 3 月进行。我们利用全球联邦健康研究网络 TriNetX 获取了 CCS 患者的在线真实世界数据集。首先，我们比较了接受 PCI 的 CCS 患者与接受基于运动的 CR 治疗的患者。其次，我们比较了同时接受 CR+PCI 与仅接受 CR 的患者。在这两种比较中，我们通过年龄、性别、种族、合并症、药物和程序对患者进行倾向评分匹配。我们确定了 18 个月内全因死亡率、再住院率和心血管合并症（中风、急性心肌梗死（AMI）和新发心力衰竭）的发生率。初始队列包括 18383 例 CCS 患者。经过倾向评分匹配后，与 PCI 相比，基于运动的 CR 显著降低了全因死亡率[0.37（95%置信区间（CI）：0.29-0.47）]、再住院率[0.29（95% CI：0.27-0.32）]和心血管合并症的几率。随后，同时接受 CR+PCI 的患者与仅接受 CR 的患者相比，全因死亡率[1.00（95% CI：0.63-1.60）]、再住院率[1.00（95% CI：0.82-1.23）]、AMI[1.11（95% CI：0.68-1.81）]和中风[0.71（95% CI：0.39-1.31）]的几率没有显著差异。
与 PCI 相比，CCS 患者接受基于运动的 CR 治疗 18 个月后全因死亡率、再住院率和心血管发病率显著降低，而将 PCI 与基于运动的 CR 相结合仅与较低的心力衰竭发生率相关。
