Prediction of Long-Term Prognosis in 12 169 Men Referred for Cardiac Rehabilitation

  • Terence Kavanagh
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Donald J. Mertens
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Larry F. Hamm
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Joseph Beyene
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Johanna Kennedy
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Paul Corey
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.
  • Roy J. Shephard
    From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.

抄録

<jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Background</jats:italic> </jats:bold> — </jats:italic> </jats:bold> Predicting the risk of cardiac and all-cause death in patients with established coronary heart disease is important in counseling the individual and designing risk-stratified rehabilitation and secondary prevention programs. Cox proportional hazards and Kaplan-Meier survival curves were thus completed on initial assessment data obtained from patients referred to an outpatient cardiac rehabilitation center. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Methods and Results</jats:italic> </jats:bold> — </jats:italic> </jats:bold> A single-center prospective observational design took peak cardiorespiratory exercise test data for 12 169 male rehabilitation candidates aged 55.0±9.6 years (7096 myocardial infarctions [MIs], 3077 coronary artery bypass grafts [CABGs], and 1996 documented cases of ischemic heart disease [IHD]). A follow-up of 4 to 29 years (median, 7.9) yielded 107 698 man-years of experience. Entry data were tested for associations with time to cardiac and all-cause death. We recorded 1336 cardiac deaths (953 MI, 225 CABG, and 158 IHD) and 2352 all-cause deaths. A powerful predictor of cardiac and all-cause mortality was measured peak oxygen intake (V̇ <jats:sc>o</jats:sc> <jats:sub>2peak</jats:sub> ). For the overall sample, values of <15, 15 to 22, and >22 mL/kg per minute yielded respective multivariate adjusted hazard ratios of 1.00, 0.62, and 0.39 for cardiac and 1.00, 0.66, and 0.45 for all-cause deaths. For the separate diagnostic categories, apart from V̇ <jats:sc>o</jats:sc> <jats:sub>2peak</jats:sub> , the only other significant predictors of cardiac death common to all 3 were smoking and digoxin, and for all-cause death, age, smoking, digoxin, and diabetes. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Conclusions</jats:italic> </jats:bold> — </jats:italic> </jats:bold> Exercise capacity, as determined by direct measurement of V̇ <jats:sc>o</jats:sc> <jats:sub>2peak</jats:sub> , exerts a major long-term influence on prognosis in men after MI, CABG, or IHD and can play a valuable role in risk stratification and counseling. </jats:p>

収録刊行物

  • Circulation

    Circulation 106 (6), 666-671, 2002-08-06

    Ovid Technologies (Wolters Kluwer Health)

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