运动为基础的心脏康复与经皮冠状动脉介入治疗慢性冠状动脉综合征：对发病率和死亡率的影响。

Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality.

机构信息

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.

出版信息

Eur J Prev Cardiol. 2022 May 25;29(7):1074-1080. doi: 10.1093/eurjpc/zwab191.

DOI:10.1093/eurjpc/zwab191

PMID:34788451

Abstract

AIMS

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.

METHODS AND RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

方法和结果

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。