title: High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project.
abstract: OBJECTIVE
  To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI).
  
  
  METHODS
  This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI.
  
  
  RESULTS
  The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001).
  
  
  CONCLUSIONS
  Higher baseline EC was independently associated with a lower risk of early death after a first MI.
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL.
authors: Gabriel E
authors: GE
authors: Shaya
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia; Henry Ford Hospital, Detroit, MI.
authors: Mouaz H
authors: MH
authors: Al-Mallah
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors: Rupert K
authors: RK
authors: Hung
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami.
authors: Khurram
authors: K
authors: Nasir
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
authors: Roger S
authors: RS
authors: Blumenthal
authors: Henry Ford Hospital, Detroit, MI.
authors: Jonathan K
authors: JK
authors: Ehrman
authors: Henry Ford Hospital, Detroit, MI.
authors: Steven J
authors: SJ
authors: Keteyian
authors: Henry Ford Hospital, Detroit, MI.
authors: Clinton A
authors: CA
authors: Brawner
authors: Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Waqas T
authors: WT
authors: Qureshi
authors: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. Electronic address: Mblaha1@jhmi.edu.
authors: Michael J
authors: MJ
authors: Blaha
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055686:Metabolic Equivalent / Q000502:physiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D010809:Physical Fitness / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology