心脏康复依从性在多支病变冠心病患者经皮冠状动脉介入术后心功能改善中的单中心研究OA

Objective:To evaluate the association between cardiac rehabilitation(CR)compliance and the improvement of left ventricular ejection fraction(LVEF)as well as cardiovascular readmission within 1 year in patients with multivessel coronary artery disease(CAD)after percutaneous coronary intervention(PCI),and to explore the effect heterogeneity in different subgroups.Methods:This was a single-center retrospective cohort study.A total of 200 patients with multivessel CAD who underwent PCI and had complete follow-up data in Huai'an Rehabilitation Hospital from December 2023 to December 2024 were enrolled.According to the completion rate of CR program,the patients were divided into the high compliance group(≥70％,n=70),moderate compliance group(40％-69％,n=60)and low compliance group(＜40％ or non-participation,n=70).The primary endpoints were LVEF improvement(ΔLVEF＞0)during follow-up and cardiovascular readmission within 1 year.Multivariate Logistic regression analysis was used to identify independent associations,and subgroup and interaction analyses were performed by age,gender,diabetes status and revascularization status.Results:The baseline demographic and clinical characteristics were generally balanced among the three groups.The proportion of incomplete revascularization in the low compliance group was significantly higher than that in the high compliance group(70.0％vs.50.0％,P=0.034),while the proportion of good medication compliance was significantly lower(45.7％vs.90.0％,P＜0.001).There were statistically significant differences in the incidence of LVEF improvement(70.0％,50.0％,30.0％)and 1-year cardiovascular readmission rate(14.3％,25.0％,35.7％)among the high,moderate and low compliance groups(both P＜0.05).Multivariate analysis showed that compared with the high compliance group,the moderate compliance group(OR=0.52,95％CI:0.28-0.98,P=0.041)and low compliance group(OR=0.30,95％CI:0.16-0.57,P＜0.001)had a significantly lower probability of LVEF improvement,and the risk of readmission increased by 1.92 times(OR=1.92,95％CI:1.03-3.59,P=0.039)and 3.25 times(OR=3.25,95％CI:1.76-6.01,P＜0.001),respectively.Incomplete revascularization(P=0.013),poor medication compliance(P=0.005)and baseline LVEF＜50％(P=0.007)were independent predictors of adverse outcomes.Subgroup analysis indicated that the beneficial effect of CR compliance was more pronounced in patients aged ≥ 65 years and those with incomplete revascularization,and there was a significant interaction between revascularization status and CR compliance(P=0.040).Conclusion:In patients with multivessel CAD after PCI,CR compliance has an independent and dose-dependent association with LVEF improvement and reduced risk of cardiovascular readmission.A comprehensive intervention approach combining complete revascularization and good medication compliance can maximize the clinical benefits of CR.It is particularly recommended to strengthen the management of CR compliance in elderly patients and those with incomplete revascularization.