대한간호학회지 (Journal of Korean Academy of Nursing)

한국간호과학회 (Korean Society of Nursing Science)
권호 표지
DOI QR코드

DOI QR Code

경피적 관상동맥 중재술을 시행한 대상자에게 적용한 비약물적 중재가 주요 심혈관 사건에 미치는 효과: 체계적 문헌고찰과 메타분석

Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis

  • 조소정 (부산대학교 간호대학) ;
  • 이해정 (부산대학교 간호대학.간호과학연구소) ;
  • 박가은 (부산대학교 간호대학.간호과학연구소)
  • Jo, Sojeong (College of Nursing, Pusan National University) ;
  • Lee, Haejung (College of Nursing.Research Institute of Nursing Science, Pusan National University) ;
  • Park, Gaeun (College of Nursing.Research Institute of Nursing Science, Pusan National University)
  • 투고 : 2024.02.16
  • 심사 : 2024.06.11
  • 발행 : 2024.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). Methods: A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2). Results: Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality. Conclusion: Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).

키워드

과제정보

This study was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education in 2023 (No. RS-2023-00250276).

참고문헌

  1. World Health Organization (WHO). Cardiovascular diseases (CVDs) [Internet]. WHO; 2021 [cited 2021 Jun 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
  2. Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, et al. The current status of percutaneous coronary intervention in Korea: Based on year 2014 cohort of Korean percutaneous coronary intervention (K-PCI) registry. Korean Circulation Journal. 2017;47(3):328-340. https://doi.org/10.4070/kcj.2017.0071
  3. Moreno PR, Stone GW, Gonzalez-Lengua CA, Puskas JD. The hybrid coronary approach for optimal revascularization: JACC review topic of the week. Journal of the American College of Cardiology. 2020;76(3):321-333. https://doi.org/10.1016/j.jacc.2020.04.078
  4. Zaman S, Kovoor P. Sudden cardiac death early after myocardial infarction: Pathogenesis, risk stratification, and primary prevention. Circulation. 2014;129(23):2426-2435. https://doi.org/10.1161/CIRCULATIONAHA.113.007497
  5. Madhavan MV, Kirtane AJ, Redfors B, Genereux P, Ben-Yehuda O, Palmerini T, et al. Stent-related adverse events >1 year after percutaneous coronary intervention. Journal of the American College of Cardiology. 2020;75(6):590-604. https://doi.org/10.1016/j.jacc.2019.11.058
  6. Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: A systematic review. BMC Medical Research Methodology. 2021;21(1):241. https://doi.org/10.1186/s12874-021-01440-5
  7. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63(25 Pt B):2960-2984. https://doi.org/10.1016/j.jacc.2013.11.003
  8. Winzer EB, Woitek F, Linke A. Physical activity in the prevention and treatment of coronary artery disease. Journal of the American Heart Association. 2018;7(4):e007725. https://doi.org/10.1161/JAHA.117.007725
  9. Kim C. Overview of cardiac rehabilitation and current situations in Korea. Annals of CardioPulmonary Rehabilitation. 2021;1(1):6-16. https://doi.org/10.53476/acpr.2021.1.1.6
  10. Toth-Zsamboki E, Horvath Z, Hajtman L, Lee S, Pallinger E, Kuklis E, et al. Cardiac rehabilitation programme as a non-pharmacological platelet inhibitory tool in acute coronary syndrome survivors. European Journal of Preventive Cardiology. 2017;24(11):1148-1156. https://doi.org/10.1177/2047487317704937
  11. Ades PA, Keteyian SJ, Wright JS, Hamm LF, Lui K, Newlin K, et al. Increasing cardiac rehabilitation participation from 20% to 70%: A road map from the million hearts cardiac rehabilitation collaborative. Mayo Clinic Proceedings. 2017;92(2):234-242. https://doi.org/10.1016/j.mayocp.2016.10.014
  12. Fleg JL. Exercise therapy for older heart failure patients. Heart Failure Clinics. 2017;13(3):607-617. https://doi.org/10.1016/j.hfc.2017.02.012
  13. Jia L, Guo Q, Wang P, Qiu S, Fan H. Effect and mechanism of exercise for patients with cardiovascular diseases. Chinese Journal of Rehabilitation Theory and Practice. 2016;22(9):1041-1044.
  14. Choi EH, Kim MJ, Lee EN. A meta-analysis on the effects of mind-body therapy on patients with irritable bowel syndrome. Journal of Korean Academy of Nursing. 2020;50(3):385-400. https://doi.org/10.4040/jkan.19224
  15. Kim SJ, Jung HM. Effects of family-participated cardiac rehabilitation program on self-efficacy, health behavior compliance, and family support of patients with percutaneous coronary intervention. Journal of Korean Clinical Nursing Research. 2015;21(2):143-153. https://doi.org/10.22650/JKCNR.2015.21.2.143
  16. Corones-Watkins KM, Theobald KA, White KM. Outcomes of a randomised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention. Australian Critical Care. 2019;32(4):285-292. https://doi.org/10.1016/j.aucc.2018.06.009
  17. Li H, Lu L, Han Z, Liu Z, Pan J, Wang Y, et al. Effect of different exercise regimens on LVEF and restenosis incidence in patients after PCI: A network meta-analysis and an overview of systematic reviews. Frontiers in Cardiovascular Medicine. 2023;10:1241343. https://doi.org/10.3389/fcvm.2023.1241343
  18. Zhang H, Chang R. Effects of exercise after percutaneous coronary intervention on cardiac function and cardiovascular adverse events in patients with coronary heart disease: Systematic review and meta-analysis. Journal of Sports Science & Medicine. 2019;18(2):213-222.
  19. Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, et al. Comparative effectiveness of the core components of cardiac rehabilitation on mortality and morbidity: A systematic review and network meta-analysis. Journal of Clinical Medicine. 2018;7(12):514. https://doi.org/10.3390/jcm7120514
  20. Welton NJ, Caldwell DM, Adamopoulos E, Vedhara K. Mixed treatment comparison meta-analysis of complex interventions: Psychological interventions in coronary heart disease. American Journal of Epidemiology. 2009;169(9):1158-1165. https://doi.org/10.1093/aje/kwp014
  21. De Luca L, Rosano GMC, Spoletini I. Post-percutaneous coronary intervention angina: From physiopathological mechanisms to individualized treatment. Cardiology Journal. 2022;29(5):850-857. https://doi.org/10.5603/CJ.a2021.0042
  22. Ambrosetti M, Abreu A, Corra U, Davos CH, Hansen D, Frederix I, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2021;28(5):460-495. https://doi.org/10.1177/2047487320913379
  23. Pedroni C, Djuric O, Bassi MC, Mione L, Caleffi D, Testa G, et al. Elements characterising multicomponent interventions used to improve disease management models and clinical pathways in acute and chronic heart failure: A scoping review. Healthcare. 2023;11(9):1227. https://doi.org/10.3390/healthcare11091227
  24. Kim SY, Park DA, Seo HJ, Shin SS, Lee SJ, Jang BH, et al. NECA's guidance for assessing tools of risk of bias. National Evidence-based Healthcare Collaborating Agency; 2021. p. 1-178.
  25. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. British Medical Journal. 2021;372:n71. https://doi.org/10.1136/bmj.n71
  26. Xu N, Wang C, Wan J, Liu X, Li Z, Chen M. Effectiveness of pharmacist intervention in the management of coronary artery disease after index percutaneous coronary intervention: A single center randomized controlled trial. International Journal of Clinical and Experimental Medicine. 2019;12(6):7760-7765.
  27. Du L, Dong P, Jia J, Li Z, Lai L, Yang X, et al. Impacts of intensive follow-up on the long-term prognosis of percutaneous coronary intervention in acute coronary syndrome patients - a single center prospective randomized controlled study in a Chinese population. European Journal of Preventive Cardiology. 2016;23(10):1077-1085. https://doi.org/10.1177/2047487315607041
  28. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. British Medical Journal. 2003;327(7414):557-560. https://doi.org/10.1136/bmj.327.7414.557
  29. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. British Medical Journal. 1997;315(7109):629-634. https://doi.org/10.1136/bmj.315.7109.629
  30. Hofman-Bang C, Lisspers J, Nordlander R, Nygren A, Sundin O, Ohman A, et al. Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty. A randomized study of a multifactorial programme. European Heart Journal. 1999;20(20):1465-1474. https://doi.org/10.1053/euhj.1999.1544
  31. Lisspers J, Sundin O, Ohman A, Hofman-Bang C, Ryden L, Nygren A. Long-term effects of lifestyle behavior change in coronary artery disease: Effects on recurrent coronary events after percutaneous coronary intervention. Health Psychology. 2005;24(1):41-48. https://doi.org/10.1037/0278-6133.24.1.41
  32. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions [Internet]. Version 6.4. Cochrane; 2023 [cited 2023 Aug 22]. Available from: https://training.cochrane.org/handbook.
  33. Kubo H, Hirai H, Machii K. Exercise training and the prevention of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Annals of the Academy of Medicine, Singapore. 1992;21(1):42-46.
  34. Guo J, Zhang H, Zhang H, Zhang L, Zhao L. Application of continuous nursing based on WeChat platform in patients with coronary heart disease after intervention therapy. Investigacion Clinica. 2020;61(1):298-305.
  35. Xiao M, Li Y, Guan X. Community-based physical rehabilitation after percutaneous coronary intervention for acute myocardial infarction. The Texas Heart Institute Journal. 2021;48(2):e197103. https://doi.org/10.14503/THIJ-19-7103
  36. Widmer RJ, Allison TG, Lennon R, Lopez-Jimenez F, Lerman LO, Lerman A. Digital health intervention during cardiac rehabilitation: A randomized controlled trial. American Heart Journal. 2017;188:65-72. https://doi.org/10.1016/j.ahj.2017.02.016
  37. Wu Q, Zhang D, Zhao Q, Liu L, He Z, Chen Y, et al. Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial. PLoS One. 2019;14(5):e0217535. https://doi.org/10.1371/journal.pone.0217535
  38. Li Z, Hui Z, Zheng Y, Yu J, Zhang J. Efficacy of phase II remote home rehabilitation in patients with acute myocardial infarction after percutaneous coronary intervention. Contrast Media & Molecular Imaging. 2022;2022:4634769. https://doi.org/10.1155/2022/4634769
  39. Yin S, Ou Y, Ting E. Impacts of Omaha System-based continuing care on the medication compliance, quality of life, and prognosis of coronary heart disease patients after PCI. Brazilian Journal of Cardiovascular Surgery. 2022;37(4):472-480. https://doi.org/10.21470/1678-9741-2021-0222
  40. Liu H, Zhang H, Qin Y, Li C, Jiao Y. Study on out-of-hospital management mode of patients with acute coronary syndrome after PCI in rural areas. International Heart Journal. 2022;63(6):1026-1033. https://doi.org/10.1536/ihj.22-203
  41. Kamel H, Hafez MS, Bastawy I. Telemedicine improves the short-term medical care of acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Frontiers in Cardiovascular Medicine. 2021;8:693731. https://doi.org/10.3389/fcvm.2021.693731
  42. Zhang Y, Cao H, Jiang P, Tang H. Cardiac rehabilitation in acute myocardial infarction patients after percutaneous coronary intervention: A community-based study. Medicine. 2018;97(8):e9785. https://doi.org/10.1097/MD.0000000000009785
  43. Back M, Wennerblom B, Wittboldt S, Cider A. Effects of high frequency exercise in patients before and after elective percutaneous coronary intervention. European Journal of Cardiovascular Nursing. 2008;7(4):307-313. https://doi.org/10.1016/j.ejcnurse.2008.02.001
  44. Belardinelli R, Paolini I, Cianci G, Piva R, Georgiou D, Purcaro A. Exercise training intervention after coronary angioplasty: The ETICA trial. Journal of the American College of Cardiology. 2001;37(7):1891-1900. https://doi.org/10.1016/s0735-1097(01)01236-0
  45. Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation: A randomized controlled trial evaluating the relationship to endothelial function and inflammation. American Heart Journal. 2009;158(5):734-741. https://doi.org/10.1016/j.ahj.2009.08.021
  46. Yang Y, Sun L, Feng W, Sun D. Observation of the effect of a 7-day gradual early functional exercise program in middle-aged and young patients with acute myocardial infarction after percutaneous coronary intervention. Annals of Palliative Medicine. 2021;10(1):258-265. https://doi.org/10.21037/apm-20-2243
  47. Chen B, Yu S. Effect of whole-course medication education method on drug literacy and complications of elderly patients with coronary heart disease after percutaneous coronary intervention. Acta Medica Mediterranea. 2022;38(5):3531-3537. https://doi.org/10.19193/0393-6384_2022_5_521
  48. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology. 2016;67(1):1-12. https://doi.org/10.1016/j.jacc.2015.10.044
  49. Graham HL, Lac A, Lee H, Benton MJ. Predicting long-term mortality, morbidity, and survival outcomes following a cardiac event: A cardiac rehabilitation study. Rehabilitation Process and Outcome. 2019;8:1179572719827610. https://doi.org/10.1177/1179572719827610
  50. Ben-Yehuda O, Kazi DS, Bonafede M, Wade SW, Machacz SF, Stephens LA, et al. Angina and associated healthcare costs following percutaneous coronary intervention: A real-world analysis from a multi-payer database. Catheterization and Cardiovascular Interventions. 2016;88(7):1017-1024. https://doi.org/10.1002/ccd.26365
  51. Cheng Z, Shi Y, Peng H, Zhao D, Fan Q, Liu J. Prognostic significance of percutaneous coronary intervention for first acute myocardial infarction with heart failure: Five-year follow-up results. Cardiology Research and Practice. 2022;2022:5791295. https://doi.org/10.1155/2022/5791295
  52. Hancock SL, Thayabaranathan T, Cameron J, Stolwyk R, Lawrence M, Johnson L, et al. Comparisons between group- and individual-based interventions to support recovery from stroke and ischaemic heart disease in the community: A scoping review. Disability and Rehabilitation. Forthcoming 2024 Jan 27.
  53. Jacobsson RJ, Oikarinen A, Krogell J, Kankkunen P. Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review. Clinical Rehabilitation. 2024;38(2):184-201. https://doi.org/10.1177/02692155231202855
  54. Yamamoto S, Yamaga T, Sakai Y, Ishida T, Nakasone S, Ohira M, et al. Association between physical performance and cardiovascular events in patients with coronary artery disease: Protocol for a meta-analysis. Systematic Reviews. 2016;5:32. https://doi.org/10.1186/s13643-016-0206-8
  55. Health Insurance Review and Assessment Service (HIRA). Evaluation report on the suitability of coronary artery bypass grafting in 2019 [Internet]. HIRA; 2019 [cited 2019 Dec 16]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2019_03.pdf.