AN OVERVIEW OF RANDOMIZED TRIALS OF REHABILITATION WITH EXERCISE AFTER MYOCARDIAL-INFARCTION
AN OVERVIEW OF RANDOMIZED TRIALS OF REHABILITATION WITH EXERCISE AFTER MYOCARDIAL-INFARCTION
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DOI：
10.1161/01.cir.80.2.234
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发表时间：
1989-08-01
期刊：
影响因子：
37.8
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
--
作者：
OCONNOR, GT;BURING, JE;HENNEKENS, CH
在 22 项心肌梗塞 (MI) 后运动康复的随机试验中，其中一项试验的结果达到了传统的统计学显着性。为了确定这些研究总体上是否显示出心肌梗塞后的显着益处或康复，我们对所有涉及 4,554 名患者的随机试验进行了概述；我们评估了总死亡率和心血管死亡率、猝死以及致死性和非致死性再梗塞。对于每个终点，我们计算了合并试验的比值比 (OR) 和 95% 置信区间 (95% CI)。平均 3 年随访后，康复组的 OR 显着低于对照组：具体而言，总死亡率（OR = 0.80 [0.66, 0.96]）、心血管死亡率（OR = 0.78 [0.63, 0.96]）和致命性再梗塞（OR = 0.75 [0.59, 0.95]）。 1 年时，康复组猝死的 OR 显着低于对照组（OR = 0.63 [0.41, 0.97]）。这些数据与 2 年（OR = 0.76 [0.54, 1.06]）和 3 年（OR = 0.92 [0.69, 1.23]）时的获益一致，但这些发现不具有统计学意义。对于非致命性再梗塞，随访 1 年（OR = 1.09 [0.76, 1.57]）、2 年（OR = 1.10 [0.82, 1.47]）或 3 年（OR = 1.09 [0.88, 1.34]）后两组之间没有显着差异。观察到的总体死亡率降低了 20%，这反映了至少 3 年内心血管死亡和致命性再梗塞风险的降低，以及梗塞后第一年甚至可能持续 2-3 年猝死率的降低。关于心脏康复中体育锻炼部分的独立影响，“仅锻炼”试验的数量相对较少，加上它们可能有正式或非正式的非锻炼部分的可能性，排除了得出任何明确结论的可能性。为此，需要进行足够规模的随机试验，以根据本概述的结果区分没有效果和最可能的效果。
Of 22 randomized trials of rehabilitation with exercise after myocardial infarction (MI), one trial had results that achieved conventional statistical significance. To determine whether or not these studies, in the aggregate, show a significant benefit or rehabilitation after myocardial infarction, we performed an overview of all randomized trials, involving 4,554 patients; we evaluated total and cardiovascular mortality, sudden death, and fatal and nonfatal reinfarction. For each endpoint, we calculated an odds ratio (OR) and 95% confidence interval (95% CI) for the trials combined. After an average of 3 years of follow-up, the ORs wer significantly lower in the rehabilitation than in the comparison group: specifically, total mortality (OR = 0.80 [0.66, 0.96]), cardiovascular mortality (OR = 0.78 [0.63, 0.96]), and fatal reinfarction (OR = 0.75 [0.59, 0.95]). The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year (OR = 0.63 [0.41, 0.97]). The data were compatible with a benefit at 2 (OR = 0.76 [0.54, 1.06]) and 3 years (OR = 0.92 [0.69, 1.23]), but these findings were not statistically significant. For nonfatal reinfarction, there was no significant differences between the two groups after 1 (OR = 1.09 [0.76, 1.57]), 2 (OR = 1.10 [0.82, 1.47]), or 3 years (OR = 1.09 [0.88, 1.34]) of follow-up. The observed 20% reduction in overall mortality reflects a decreased risk of cardiovascular mortality and fatal reinfarction throughout at least 3 years and a reduction in sudden death during the 1st year after infarction and possibly for 2-3 years. With respect to the independent effects of the physical exercise component of cardiac rehabilitation, the relatively small number of "exercise only" trials, combined with the possibility that they may have had a formal or informal nonexercise component precludes the possibility of reaching any definitive conclusion. To do so would require a randomized trial of suffcient size to distinguish between no effect and the most plausible effect based on the results of this overview.