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Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing)
Rupert K Hung1, Mouaz H Al-Mallah2, John W McEvoy1
1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
Insights
Exercise capacity strongly predicts outcomes in coronary artery disease (CAD). Higher exercise capacity in patients with CAD, regardless of revascularization, is linked to better survival and fewer cardiac events.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Exercise Physiology
Background:
- Coronary artery disease (CAD) management involves assessing prognosis.
- Exercise capacity is a key indicator of cardiovascular health.
- The prognostic value of exercise capacity in revascularized vs. nonrevascularized CAD patients needs clarification.
Purpose of the Study:
- To evaluate the prognostic significance of exercise capacity in patients with coronary artery disease (CAD).
- To compare the prognostic value of exercise capacity between nonrevascularized and revascularized CAD patients (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG] surgery).
Main Methods:
- Retrospective cohort study of 9852 adults with known CAD.
- Patients categorized by revascularization status (nonrevascularized, PCI, CABG) and exercise capacity (METs).
- Cox regression models adjusted for confounders to assess mortality, myocardial infarction (MI), and downstream revascularization risks.
Main Results:
- Each 1-MET increase in exercise capacity significantly reduced mortality, MI, and downstream revascularization risks across all groups.
- Nonrevascularized patients showed similar mortality but higher MI and revascularization risks compared to PCI/CABG patients at similar exercise capacities.
- Exercise capacity demonstrated a strong, independent prognostic value for adverse cardiovascular events.
Conclusions:
- Exercise capacity is a powerful predictor of mortality, MI, and downstream revascularizations in patients with CAD.
- Similar exercise capacities confer equivalent mortality risk, regardless of prior revascularization status.
- Exercise testing provides crucial prognostic information for guiding clinical management in CAD patients.
Objective:
To examine the prognostic value of exercise capacity in patients with nonrevascularized and revascularized coronary artery disease (CAD) seen in routine clinical practice.
Patients And Methods:
We analyzed 9852 adults with known CAD (mean ± SD age, 61±12 years; 69% men [n=6836], 31% black race [n=3005]) from The Henry Ford ExercIse Testing (FIT) Project, a retrospective cohort study of patients who underwent physician-referred stress testing at a single health care system between January 1, 1991, and May 31, 2009. Patients were categorized by revascularization status (nonrevascularized, percutaneous coronary intervention [PCI], or coronary artery bypass graft [CABG] surgery) and by metabolic equivalents (METs) achieved on stress testing. Using Cox regression models, hazard ratios for mortality, myocardial infarction (MI), and downstream revascularizations were calculated after adjusting for potential confounders, including cardiac risk factors, pertinent medications, and stress testing indication.
Results:
There were 3824 all-cause deaths during median follow-up of 11.5 years. In addition, 1880 MIs, and 1930 revascularizations were ascertained. Each 1-MET increment in exercise capacity was associated with a hazard ratio (95% CI) of 0.87 (0.85-0.89), 0.87 (0.85-0.90), and 0.86 (0.84-0.89) for mortality; 0.98 (0.96-1.01), 0.88 (0.84-0.92), and 0.93 (0.90-0.97) for MI; and 0.94 (0.92-0.96), 0.91 (0.88-0.95), and 0.96 (0.92-0.99) for downstream revascularizations in the nonrevascularized, PCI, and CABG groups, respectively. In each MET category, the nonrevascularized group had similar mortality risk as and higher MI and downstream revascularization risk than the PCI and CABG surgery groups (P<.05).
Conclusion:
Exercise capacity was a strong predictor of mortality, MI, and downstream revascularizations in this cohort. Furthermore, patients with similar exercise capacities had an equivalent mortality risk, irrespective of baseline revascularization status.
