Elsevier

American Heart Journal

Volume 156, Issue 2, August 2008, Pages 292-300
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Peak aerobic capacity predicts prognosis in patients with coronary heart disease

https://doi.org/10.1016/j.ahj.2008.03.017Get rights and content

Background

It is unknown if contemporary preventive treatments such as statins or primary percutaneous coronary intervention in patients with coronary heart disease (CHD) have rendered obsolete the use of measured exercise capacity for assessment of future risk and prognosis. Using a sample of patients from 2 clinical sites, most of whom were taking β-blockade, antiplatelet, and statin therapy, we hypothesized that peak oxygen consumption (Vo2) would remain a strong and independent predictor of all-cause and cardiovascular-specific mortality in men and women with CHD.

Methods

We studied 2,812 patients with CHD between 1996 and 2004. All-cause and cardiovascular disease–specific mortality served as end points.

Results

In all men and women and in a subgroup of patients following evidence-based care, peak Vo2 remained a strong predictor of all-cause death, with every 1 mL·kg−1·min−1 increase in peak Vo2 associated with an approximate 15% decrease in risk of death. Among men, a peak Vo2 (mL·kg−1·min−1) below ∼15 was associated with the highest risk, whereas a peak Vo2 above ∼19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak Vo2 below ∼12 was associated with the highest risk, whereas a peak Vo2 above ∼16.5 was associated with the lowest rate and risk for annual all-cause mortality.

Conclusions

In men and women with CHD, peak Vo2 remains an independent predictor of all-cause and cardiovascular-specific mortality.

Section snippets

Study population

Between January 1996 and December 2004, we assessed 2,812 consecutive patients with a recent acute cardiac event requiring hospitalization that resulted in referral and entry into cardiac rehabilitation in Detroit, MI (n = 1,392), and Burlington, VT (n = 1,420). Cardiopulmonary exercise testing was performed (vs standard stress testing) as a standard baseline evaluation for cardiac rehabilitation entrants for both clinical and research purposes. If more than one cardiac diagnosis was recorded

Results

Table I describes demographic, clinical, and peak exercise characteristics for patients in this study. Of the total sample, 83% of patients were taking an antiplatelet agent, 75% of patients were taking a β-adrenergic receptor blocking agent, and 61% of patients were on a lipid-lowering agent; and 1,391 (∼50%) patients reported taking an evidence-based medical regimen consistent with their index event. Median follow-up period was 59 months and there were 280 total deaths.

Among men, univariable

Discussion

The primary finding of this article is that peak Vo2 remains an independent predictor of all-cause and cardiovascular-specific mortality in men and women, as determined in a cohort of patients (N = 2,812) with cardiovascular disease and referred to cardiac rehabilitation. In this group of patients, all were assessed during treadmill testing and most patients were being treated with agents consistent with contemporary evidence-based guidelines. Based on these findings, we accept our original

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