Cardiac rehabilitation, especially exercise, may benefit post-percutaneous coronary intervention (PCI) patients with coronary heart disease; however, the average rate of cardiac rehabilitation is low, and there is no patient management scheme with strong operability yet. |
Compared with only routine post-procedure education, cardiac rehabilitation combining cardiopulmonary exercise testing (CPET) with cardiac education could improve physical activity and quality of life for patients after PCI (p < 0.05). |
Cardiac rehabilitation combining at least one-time CPET with a systematic cardiac education program before discharge improved engagement in physical activity and quality of life without increasing adverse events. |
The conclusion of this article is helpful to promote our experience in China, which may benefit more patients and offer a good role in the Chinese cardiac rehabilitation field, and it may also provide a patient management scheme for post-PCI patients in other areas outside China. |
Introduction
Methods
Data Collection
Cardiopulmonary Function Exercise Test (CPET)
Systematic Education of CR After CPET
Outcomes Process
Follow-up
Statistical analyses
Variable | Before propensity score matching | After propensity score matching | ||||||
---|---|---|---|---|---|---|---|---|
Control | CR | p value | Control | CR | Standardized difference | p value | ||
(N = 6808) | (N = 4001) | (N = 2805) | (N = 2805) | |||||
Age (years) | 61.34 ± 10.67 | 57.42 ± 9.46 | < 0.01 | 59.14 ± 10.11 | 58.89 ± 8.96 | 0.026 | 0.329 | |
Men | 5040 (74%) | 3108 (77.7%) | < 0.01 | 2114 (75.4%) | 2095 (74.7%) | 0.016 | 0.558 | |
Type of acute coronary syndrome | ||||||||
Unstable angina | 4288 (63%) | 3227 (80.7%) | < 0.01 | 2172 (77.4%) | 2165 (77.2%) | 0.006 | 0.823 | |
STEMI | 1495 (22%) | 415 (10.4%) | < 0.01 | 351 (12.5%) | 353 (12.6%) | 0.002 | 0.936 | |
NSTE-ACS | 1021 (15%) | 359 (9%) | < 0.01 | 282 (10.1%) | 287 (10.2%) | 0.006 | 0.825 | |
Hypertension | 3992 (58.6%) | 2213 (55.3%) | < 0.01 | 1571 (56%) | 1519 (54.2%) | 0.037 | 0.163 | |
Diabetes | 1961 (28.8%) | 893 (22.3%) | < 0.01 | 644 (23%) | 674 (24%) | 0.025 | 0.345 | |
Smoking | 3254 (47.8%) | 2307 (57.7%) | < 0.01 | 1552 (55.3%) | 1567 (55.9%) | 0.011 | 0.687 | |
Previous PCI | 1406 (20.7%) | 623 (15.6%) | < 0.01 | 446 (15.9%) | 501 (17.9%) | 0.052 | 0.054 | |
Prior stroke | 387 (5.7%) | 110 (2.7%) | < 0.01 | 93 (3.3%) | 93 (3.3%) | 0.000 | 1 | |
Ejection fraction, % | 57.76 ± 8.67 | 61.83 ± 7.48 | < 0.01 | 60.53 ± 7.03 | 60.66 ± 7.49 | 0.018 | 0.491 |
Medication | Before propensity score matching | After propensity score matching | |||||
---|---|---|---|---|---|---|---|
Control | CR | p value | Control | CR | Standardized difference | p value | |
(N = 6808) | (N = 4001) | (N = 2805) | (N = 2805) | ||||
Aspirin | 6803 (99.9%) | 3997 (99.9%) | 0.644 | 2805 (100%) | 2805 (100%) | 0.000 | 1 |
P2Y12 inhibitor | 6808 (100%) | 4001 (100%) | 1 | 2805 (100%) | 2805 (100%) | 0.000 | 1 |
ACEI/ARB | 5190 (76.2%) | 3068 (76.7%) | 0.597 | 2147 (76.5%) | 2123 (75.7%) | 0.020 | 0.452 |
β blocker | 5153 (75.7%) | 3252 (81.3%) | < 0.01 | 2244 (80%) | 2228 (79.4%) | 0.014 | 0.595 |
Nitrate | 4444 (65.3%) | 2687 (67.2%) | 0.046 | 1892 (67.5%) | 1873 (66.8%) | 0.014 | 0.589 |
Statin | 6719 (98.7%) | 3995 (99.9%) | < 0.01 | 2802 (99.9%) | 2799 (99.8%) | 0.027 | 0.317 |
Results
Long-term Results
Baseline Characteristics
Outcomes After Discharge
Physical activity | CR (n = 2805) | Control (n = 2805) | p value |
---|---|---|---|
Mild | 22 | 956 | < 0.05 |
Moderate | 2736 | 1849 | |
High intensity | 47 | 0 | |
Cumulative exercise time (h/week) | 8.22 ± 6.17 | 3.00 ± 1.65 | < 0.05 |
Seattle Angina Questionnaire | Before propensity score matching | After propensity score matching | ||||
---|---|---|---|---|---|---|
Control | CR | p value | Control | CR | p value | |
(N = 6808) | (N = 4001) | (N = 2805) | (N = 2805) | |||
Physical limitation | 57.68 ± 7.32 | 69.82 ± 11.26 | < 0.01 | 57.49 ± 7.19 | 69.59 ± 10.96 | < 0.01 |
Anginal stability | 58.50 ± 11.84 | 80.52 ± 18.29 | < 0.01 | 58.82 ± 11.95 | 80.50 ± 18.21 | < 0.01 |
Anginal frequency | 65.07 ± 23.67 | 78.71 ± 11.04 | < 0.01 | 67.14 ± 22.41 | 78.58 ± 11.07 | < 0.01 |
Treatment satisfaction | 57.08 ± 21.49 | 82.63 ± 13.21 | < 0.01 | 56.84 ± 21.61 | 82.33 ± 13.21 | < 0.01 |
Quality of life | 60.27 ± 16.70 | 69.66 ± 18.65 | < 0.01 | 60.26 ± 17.13 | 68.69 ± 18.33 | < 0.01 |
Outcome | Before propensity score matching | After propensity score matching | ||||
---|---|---|---|---|---|---|
Control | CR | p value | Control | CR | p value | |
(N = 6808) | (N = 4001) | (N = 2805) | (N = 2805) | |||
TVR | 54 (0.8%) | 18 (0.4%) | 0.005 | 20 (0.7%) | 13 (0.5%) | 0.222 |
Myocardial infarction | 37 (0.5%) | 22 (0.5%) | 0.398 | 20 (0.7%) | 15 (0.5%) | 0.397 |
Death | 21 (0.3%) | 8 (0.2%) | 0.292 | 7 (0.2%) | 6 (0.2%) | 0.781 |
MACE | 85 (1.2%) | 34 (0.8%) | – | 45 (1.3%) | 24 (0.8%) | — |