Peak aerobic capacity predicts prognosis in patients with coronary heart disease.
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 beta-blockade, antiplatelet, and statin therapy, we hypothesized that peak oxygen consumption (Vo(2)) 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 Vo(2) remained a strong predictor of all-cause death, with every 1 mL x kg(-1) x min(-1) increase in peak Vo(2) associated with an approximate 15% decrease in risk of death. Among men, a peak Vo(2) (mL x kg(-1) x min(-1)) below approximately 15 was associated with the highest risk, whereas a peak Vo(2) above approximately 19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak Vo(2) below approximately 12 was associated with the highest risk, whereas a peak Vo(2) above approximately 16.5 was associated with the lowest rate and risk for annual all-cause mortality.


CONCLUSIONS
In men and women with CHD, peak Vo(2) remains an independent predictor of all-cause and cardiovascular-specific mortality.
Keteyian
Steven J
SJ
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA. sketeyi1@hfhs.org
Brawner
Clinton A
CA
Savage
Patrick D
PD
Ehrman
Jonathan K
JK
Schairer
John
J
Divine
George
G
Aldred
Heather
H
Ophaug
Kristin
K
Ades
Philip A
PA
D015992:Body Mass Index; D002423:Cause of Death; D003327:Coronary Disease / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019370:Observation; D010101:Oxygen Consumption; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk