Effect Of Postoperative Exercise On The Risk Of Long-term Adverse Cardiovascular And Cerebrovascular Events After Coronary Artery Bypass Graftin

Objective To evaluate the effect of postoperative exercise on the risk of long-term major adverse cardiovascular and cerebral events after coronary artery bypass grafting.Methods 4571 patients who underwent median thoracotomy coronary artery bypass grafting in Fuwai Hospital were continuously collected.The demographic information,accompanying diseases,hospitalization and operation information were recorded,and the patients were followed up after operation.According to whether the patients kept exercise after operation,they were divided into two groups:exercise group(n=4086)and control group(n=485).Using propensity matching,survival analysis and regression analysis,the influencing factors of postoperative exercise compliance and the impact of postoperative exercise on the risk of long-term cardiovascular and cerebrovascular adverse events were identified.Results 477 cases in the control group and 1383 cases in the exercise group were obtained after matching the baseline characteristics.The average value of the followup time was 4.8 years.Compared with the control group,the exercise group had lower incidence of postoperative MACCE(31%vs.45%,P<0.001),MACE(21%vs.33%,P<0.001),stroke(13%vs.20%,P<0.001),readmission of angina pectoris(12%vs.17%,P=0.011),readmission of heart failure(13%vs.22%,P<0.001),(7%vs.18%,P<0.001),postoperative coronary DSA examination(4%vs.7%,P=0.004),bridging vessel stenosis(3%vs.5%,P=0.031)and postoperative revascularization(6%vs.9%,P=0.016).The survival analysis of matched samples showed that keeping exercise after operation significantly reduced the risk of MACCE[HR 0.62(0.52-0.74),P<0.0001],MACE[HR 0.59(0.47-0.73),P<0.0001]and stroke[HR 0.63(0.48-0.82),P=0.0002]and different exercise duration showed a dose-dependent decrease on the risk of MACCE,MACE and stroke.Using regression analysis to correct confounding factors,it was found that postoperative adherence to exercise was still associated with reduced risk of postoperative MACCE[OR 0.93(0.92-0.94),P<0.001],MACE[OR 0.94(0.93-0.95),P<0.001)]and stroke[OR 0.96(0.96-0.97),P<0.001].Female[OR 0.97(0.97-0.98),P<0.001),diabetes[OR 0.98(0.97-0.98),P<0.001]and cerebrovascular disease[OR 0.98(0.97-0.99),P=0.013]were the risk factors of low postoperative exercise compliance.Conclusion Postoperative adherence to exercise is related to the reduction of the risk of long-term cardiovascular and cerebrovascular adverse events after coronary artery bypass grafting and the risk decreases in a dose-dependent manner when the extension of exercise time lengthens.Female,diabetes and cerebrovascular disease are risk factors for low postoperative exercise compliance.Objective To evaluate the effects of metabolic syndrome and diabetes mellitus on long-term mortality and risk of cardiovascular and cerebrovascular events in patients undergoing coronary artery bypass grafting.To elucidate the effect of diabetes mellitus among the multiple component factors of metabolic syndrome.Methods The patients who underwent median thoracotomy coronary artery bypass grafting in Fuwai Hospital were collected.The basic information,accompanying diseases,hospitalization and operation were recorded and followed up after discharge.The patients were divided into three groups:metabolic syndrome combined with diabetes mellitus,metabolic syndrome without diabetes mellitus and non-metabolic syndrome.The postoperative death and complications of the three groups were compared and survival analysis was conducted.Confounding factors were adjusted by Cox multivariate regression to determine the impact of diabetes and metabolic syndrome on long-term death and adverse cardiovascular and cerebrovascular events.Results The average follow-up duration was 4.95 years.The incidence of all-cause death(7%vs.2.3%,P=0.029),cardiac death(5%vs.1.3%,P=0.033)and renal failure(5%vs.1.3%,P=0.033)were significantly higher in metabolic syndrome with diabetes than metabolic syndrome without diabetes mellitus after coronary artery bypass grafting.Using multiple factors regression analysis to correct the effects of confounding factors,the metabolic syndrome combined with diabetes mellitus still significantly increased the risk of all-cause death(HR 2.8,1.18-6.66,P=0.020)and major cardiovascular and cerebrovascular adverse events(HR 1.67,1.11-2.53,P=0.014).Metabolic syndrome without diabetes wasn’t associated with increased risk of death but led to higher hazard of major cardiovascular and cerebrovascular events(HR 1.34,1.03-1.74,P=0.029).Conclusion Metabolic syndrome with diabetes mellitus increased the risk of death and the risk of major cardiovascular and cerebrovascular diseases after coronary artery bypass grafting.Metabolic syndrome without diabetes was not associated with increasing risk of death but increasing risk of cardiovascular and cerebrovascular adverse events.Objective To evaluate the effect of persisting exercise on the risk of long-term adverse cardiovascular and cerebral events in type 2 diabetic patients undergoing coronary artery bypass grafting.Methods 1164 patients who underwent median thoracotomy coronary artery bypass grafting in Fuwai Hospital were continuously collected.The demographic information,accompanying diseases,hospitalization and operation information were recorded,and the patients were followed up after operation.According to whether the patients kept exercise after operation,they were divided into two groups:exercise group(n=1000)and control group(n=164).Using propensity matching,survival analysis and regression analysis,the impact of postoperative exercise on the risk of long-term cardiovascular and cerebrovascular adverse events were identified.Results The mean follow-up duration was 1657.2 days.Propensity score match analysis showed that patients in the persistent exercise group had lower incidence of MACCE(29.1%vs.49.1%,P<0.001),MACE(17.8%vs.34.0%,P<0.001),stroke(13.7%vs.22.0%,P=0.015),heart failure(9.0%vs.18.2%,P=0.002),second admission of angina pectoris(9.5%vs.15.7%,P=0.033),vessel restenosis(6.6%vs.17.0%,P<0.001),thrombolytic therapy(0%vs.1.9%,P=0.005)and revascularization(3.6%vs.9.4%,P=0.004)compared with the control group.Survival analysis of matched sample showed that persistent exercise reduced the occurrence risk of MACCE[HR 0.63(0.41-0.96),P=0.0025],MACE[HR 0.49(0.33-0.72),P<0.0001]and stroke[HR 0.60(0.38-0.95),P=0.0155].Survival analysis of different exercise duration groups showed that exercise 7-13.9 hours/week(χ2 18.54,P<0.001)and exercise≥ 14 hours/week(χ2 22.40,P<0.001)had better MACCE-free survival than control group.Correcting confounding factors,exercise also reduced the risk of major adverse cardiovascular and cerebral events[OR 0.92(0.90-0.94),P<0.001],major adverse cardiovascular events[OR 0.90(0.88-0.92),P=0.005]and stroke[OR 0.96(0.95-0.98),P=0.012].Conclusion Persisting exercise is associated with lower risk of long-term adverse cardiovascular and cerebral events in type 2 diabetic patients undergoing coronary artery bypass grafting.Patients undergoing coronary artery bypass grafting have more preoperative complications,high surgical risk,high incidence of postoperative complications and mortality.Lifestyle management plays an important role in the threelevel prevention strategy of coronary heart disease.Studies have shown that cardiac rehabilitation can significantly improve the short-term and long-term prognosis of patients undergoing coronary artery bypass grafting.Exercise is the core of the multidisciplinary intervention strategy of cardiac rehabilitation.Cardiac rehabilitation can be divided into stage Ⅰ,stage Ⅱ,stage Ⅲ and preoperative rehabilitation according to the intervention time.This paper reviews the research progress of exercise in perioperative rehabilitation of coronary artery bypass grafting from the above four dimensions in order to provide clinical reference.