Shi Yan, Xu Huiqing, Dong Jige
Rehabilitation Treatment Center of Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China.
Department of Anesthesiology, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China.
Int J Surg. 2025 Mar 1;111(3):2708-2721. doi: 10.1097/JS9.0000000000002268.
Currently, exercise-based cardiac rehabilitation (CR) has been receiving increasing interest for its potentially beneficial effects on the health related quality of life (HRQoL) and outcomes of patients with coronary heart disease (CHD). The aim of this study was to evaluate the effect of exercise-based CR on patients after coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI).
We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to 1 December 2023 for relevant studies that evaluated the effect of exercise-based CR on patients after CABG and PCI. Our primary outcomes included mortality, complications, hospital admissions, and HRQoL between patients receiving exercise-based CR and usual care. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.
We finally indicated and included 25 randomized controlled trials (RCTs) with 4106 participants for the present analysis. Our pooled results indicated that, compared to usual care, exercise-based CR did not increase the all-cause (relative risk, RR: 0.84; 95% confidence interval, CI: 0.54-1.31) and cardiovascular (RR: 0.98; 95% CI: 0.38-2.54) mortality for patients after coronary artery operation. Similarly, exercise-based CR had an equal effect on coronary artery complications for patients after coronary artery surgery, including CABG (RR: 0.60; 95% CI: 0.32 ‒ 1.15) and PCI (RR: 0.92; 95% CI: 0.55-1.54). It was indicated that exercise-based CR significantly reduced the incidence of myocardial infarction (MI) by half with an RR of 0.50 (95% CI: 0.28-0.90). In addition, exercise-based CR also significantly reduced all-cause hospital admissions with an RR of 0.74 (95% CI: 0.62-0.88). Compared to usual care, exercise-based CR obviously improved HRQoL of patients after coronary artery operation evaluated with SF-36 summary scores (standardized mean difference, SMD: 0.24; 95% CI: 0.11-0.38) and SF-36 8 domains (SMD: 0.35; 95% CI: 0.24-0.46).
Our analysis indicated that exercise-based CR had a significant effect on the improvement of HRQoL in patients after coronary artery surgeries without increasing mortality or the incidence of re-intervention with operations.
目前，基于运动的心脏康复（CR）因其对冠心病（CHD）患者的健康相关生活质量（HRQoL）和预后具有潜在的有益影响而受到越来越多的关注。本研究的目的是评估基于运动的CR对冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）术后患者的影响。
我们检索了从数据库建立至2023年12月1日的PubMed、Embase、Cochrane图书馆和Web of Science，以查找评估基于运动的CR对CABG和PCI术后患者影响的相关研究。我们的主要结局包括接受基于运动的CR和常规护理的患者之间的死亡率、并发症、住院率和HRQoL。所有统计分析均使用Review Manager 5.2和Stata 12.0中提供的标准统计程序进行。
我们最终确定并纳入了25项随机对照试验（RCT），共4106名参与者进行本分析。我们的汇总结果表明，与常规护理相比，基于运动的CR并未增加冠状动脉手术后患者的全因死亡率（相对风险，RR：0.84；95%置信区间，CI：0.54 - 1.31）和心血管死亡率（RR：0.98；95% CI：0.38 - 2.54）。同样，基于运动的CR对冠状动脉手术后患者的冠状动脉并发症具有相同的影响，包括CABG（RR：0.60；95% CI：0.32 - 1.15）和PCI（RR：0.92；95% CI：0.55 - 1.54）。结果表明，基于运动的CR使心肌梗死（MI）的发生率显著降低了一半，RR为0.50（95% CI：0.28 - 0.90）。此外，基于运动的CR还显著降低了全因住院率，RR为0.74（95% CI：0.62 - 0.88）。与常规护理相比，基于运动的CR通过SF - 36总结评分（标准化均值差，SMD：0.24；95% CI：0.11 - 0.38）和SF - 36八个领域（SMD：0.35；95% CI：0.24 - 0.46）评估，明显改善了冠状动脉手术后患者的HRQoL。
我们的分析表明，基于运动的CR对冠状动脉手术后患者的HRQoL改善具有显著影响，且不会增加死亡率或再次手术干预的发生率。
