Cabrera-Aguilera Ignacio, Ivern Consolació, Badosa Neus, Marco Ester, Duran Xavier, Mojón Diana, Vicente Miren, Llagostera Marc, Farré Nuria, Ruíz-Bustillo Sonia
Unit of Biophysics and Bioengineering, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08036 Barcelona, Spain.
Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain.
J Clin Med. 2022 Mar 30;11(7):1910. doi: 10.3390/jcm11071910.
Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51−9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.
已有多种风险评分用于预测急性冠状动脉综合征（ACS）后的风险，但这些风险评分均未纳入心功能分级。本研究旨在评估包括心功能分级在内的风险分层（RS）的预测价值，以及心脏康复（CR）如何改变RS。对来自前瞻性观察登记处的238例ACS患者进行低风险（L）和非低风险（NL）分层，并根据运动依从性进行分类：低风险且运动（L-E）、低风险且对照（不运动）（L-C）、非低风险且运动（NL-E）以及非低风险且对照（NL-C）。主要终点为心脏再住院。进行多变量分析以确定与主要终点独立相关的变量。L组包括56.7%的患者。NL组的主要终点发生率更高（18.4%对4.4%，p<0.001）。在多变量分析中对年龄、性别、糖尿病和运动进行校正后，心脏再住院的HR（95%CI）为3.83（1.51−9.68）。对于RS和运动，预后各不相同：L-E组的心脏再住院率为2.5%，而NL-C组为26.1%（p<0.001）。完成运动训练与重新分类为低风险相关，预后更好。这种易于计算的风险评分提供了可靠的预后信息。不运动组与最差的预后独立相关。基于运动的CR计划改变了RS，改善了分类和预后。
