title: Heart rate recovery after exercise and long-term prognosis in patients with coronary artery disease.
abstract: BACKGROUND
  The long-term prognostic value of heart rate recovery (HRR) has been incompletely documented in patients with coronary artery disease (CAD). We sought to confirm the prognostic value of HRR in a large cohort with stable CAD.
  
  
  METHODS
  From the Coronary Artery Surgery Study registry, a database of 24,958 patients with CAD who underwent cardiac catheterization between 1974 and 1979, we identified 4097 patients with baseline exercise stress testing data. HRR was measured at 3 minutes post exercise during a passive recovery. Clinical outcomes were evaluated according to HRR in both threshold and continuous models.
  
  
  RESULTS
  Median long-term follow-up was 14.7 years (interquartile range, 9.8-16.2). HRR < 46 beats per minute (Bpm) most appropriately differentiated nonsurvivors from survivors (area under receiver operating characteristic curve = 0.613) and was associated with an increased risk of all-cause death (adjusted hazard ratio = 1.15; P = 0.011). Increasing HRR was associated with a lower risk of all-cause (adjusted hazard ratio = 0.94 per 10 Bpm; 95% confidence interval, 0.91-0.97; P = 0.0005) and cardiovascular (CV) mortality (adjusted hazard ratio = 0.94 per 10 Bpm; 95% confidence interval, 0.90-0.98; P = 0.003).
  
  
  CONCLUSIONS
  HRR at 3 minutes independently predicts long-term all-cause and CV mortality in patients with stable CAD. Measurement of HRR at 3 minutes during passive recovery can be used as a complementary tool to identify patients with a higher total and CV risk.
authors.affiliation: Montreal Heart Institute Cardiovascular and Prevention Centre (Centre ÉPIC), Montreal, Québec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gayda
authors.forename: Martial G
authors.initials: MG
authors.lastname: Bourassa
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.forename: Martin
authors.initials: M
authors.lastname: Juneau
authors.forename: Anil
authors.initials: A
authors.lastname: Nigam
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries