Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
School of Medicine, University of Illinois, Springfield, Illinois, USA.
Clin Cardiol. 2022 Oct;45(10):1036-1043. doi: 10.1002/clc.23890. Epub 2022 Jul 29.
Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes.
Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events.
We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group").
Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03).
Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.
心脏康复是重大心血管不良事件后的重要治疗手段，但目前尚无相关数据表明康复表现与长期结局相关。
患者在心脏康复期间的运动表现能可靠地预测未来心血管事件。
我们进行了一项单中心研究，纳入了 2018 年 1 月至 2021 年 8 月期间参加心脏康复项目的 486 例连续患者。我们使用一种新的指数，即心脏康复评分（CR-score）来评估患者的表现，该指数综合了每个训练设备（TD）上的持续时间、工作速度和工作量。我们使用二元递归分区模型确定累积 CR 评分的最佳阈值。我们使用 Cox 回归分析评估发生主要不良心血管事件（“研究组”）和未发生主要不良心血管事件（“对照组”）患者的死亡率。
在 486 例合格患者中，1 年内发生主要不良心血管事件 27 例（5.5%），既往有脑卒中或短暂性脑缺血发作的患者更常见（14.8%比 3.5%，p<0.001）。年龄、性别、合并症、心力衰竭和药物治疗对结局无显著影响。研究组的中位数累积 CR 评分明显低于对照组（595±185.6 比 3500±1104.7，p<0.0001）。累积 CR 评分≥1132 与结局相关（98.5%的敏感性，99.6%的特异性，95%CI：0.985-0.997，面积 0.994，p<0.0001）。年龄大于 55 岁且累积 CR 评分<1132 的患者 1 年内发生主要不良心血管事件的风险特别高（OR：7.4，95%CI：2.84-18.42）（对数秩检验，p=0.03）。
我们提出的心脏康复评分能准确识别康复项目后 1 年内发生主要不良心血管事件的高危患者。需要进行多中心验证。
