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[探索新冠疫情大流行之前及期间急性冠状动脉综合征患者PCI术后心肺运动试验的特征变化]

[Exploring the characteristics changes of cardiopulmonary exercise testing in patients with acute coronary syndrome after PCI before and during the COVID-19 pandemic].

作者信息

Mu X B, Ren Q, Li Y S, Zhang J, Liang Y C, Wang Y X, Zhang Q Y, Han Y L

机构信息

Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Sep 24;52(9):1065-1072. doi: 10.3760/cma.j.cn112148-20240514-00262.

Abstract

To investigate the changes in cardiopulmonary exercise testing (CPET) characteristics before and after the outbreak of COVID-19 in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). This is a cross-sectional study that included ACS patients who underwent PCI at the General Hospital of the Northern Theater Command from July 2018 to February 2023. Based on the timeline of the COVID-19 pandemic, patients were divided into two groups: the pre-pandemic group and the during-pandemic group, with January 2020 as the dividing line. Clinical data were collected from both groups, and a comparative analysis was performed on their postoperative CPET outcomes, including peak oxygen uptake (peak VO), peak metabolic equivalents (peak MET), and other indicators. Weber's classification was used to assess cardiac function. In addition, the 7-tiem generalized anxiety disorder scale (GAD-7) and the patient health questionnaire-9 (PHQ-9) were used to assess the patients' psychological anxiety and depression states, respectively. Multivariate logistic regression was used to analyze the influencing factors of CPET after PCI. A total of 4 310 post-PCI ACS patients were included, with an average age of (58.7±9.1) years, and 3 464 (80.37%) were male. There were 1 698 patients in the pre-pandemic group and 2 612 patients in the during-pandemic group. The main indicator of the CPET, peak VO (15.04±3.93) ml·min·kg in the during-pandemic group, was lower than that in the pre-pandemic group (15.52±3.68) ml·min·kg, and the difference was statistically significant (<0.001). Multivariate logistic regression analysis showed that advanced age, female gender, high body mass index, elevated high-sensitivity C-reactive protein, reduced high-density lipoprotein cholesterol, smoking history, history of myocardial infarction, more severe ACS classification, and mild to moderate degree of depression were related to poor cardiopulmonary outcomes (<0.05). The COVID-19 pandemic had a negative impact on the cardiopulmonary outcomes of ACS patients after PCI. Reduced physical activity, and increased psychological stress should be given consideration and attention regarding their impact on patients' cardiopulmonary function.

摘要

为研究接受经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者在新型冠状病毒肺炎(COVID-19)疫情暴发前后心肺运动试验(CPET)特征的变化。这是一项横断面研究,纳入了2018年7月至2023年2月在北部战区总医院接受PCI的ACS患者。根据COVID-19大流行的时间线,以2020年1月为分界线将患者分为两组:疫情前组和疫情期间组。收集两组的临床资料,并对其术后CPET结果进行对比分析,包括峰值摄氧量(peak VO)、峰值代谢当量(peak MET)等指标。采用Weber分类法评估心功能。此外,分别采用7项广泛性焦虑障碍量表(GAD-7)和患者健康问卷9项(PHQ-9)评估患者的心理焦虑和抑郁状态。采用多因素logistic回归分析PCI术后CPET的影响因素。共纳入4310例PCI术后ACS患者,平均年龄(58.7±9.1)岁,男性3464例(80.37%)。疫情前组1698例,疫情期间组2612例。CPET的主要指标peak VO在疫情期间组为(15.04±3.93)ml·min·kg,低于疫情前组(15.52±3.68)ml·min·kg,差异有统计学意义(<0.001)。多因素logistic回归分析显示,高龄、女性、高体重指数、高敏C反应蛋白升高、高密度脂蛋白胆固醇降低、吸烟史、心肌梗死病史、更严重的ACS分类以及轻至中度抑郁程度与心肺结局不良相关(<0.05)。COVID-19大流行对PCI术后ACS患者的心肺结局有负面影响。应考虑并关注身体活动减少和心理压力增加对患者心肺功能的影响。

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