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Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing.
Arch Intern Med. 2008 Jan 28; 168(2):174-9.AI

Abstract

BACKGROUND

Little is known about the association between exercise capacity and nonfatal cardiac events in patients referred for exercise treadmill testing (ETT). Our objective was to determine the prognostic importance of exercise capacity for nonfatal cardiac events in a clinical population.

METHODS

A cohort study was performed of 9191 patients referred for ETT. Median follow-up was 2.7 years. Exercise capacity was quantified as the proportion of age- and sex-predicted metabolic equivalents achieved and categorized as less than 85%, 85% to 100%, and greater than 100%. Individual primary outcomes were myocardial infarction, unstable angina, and coronary revascularization. All-cause mortality was a secondary outcome.

RESULTS

Patients with lower exercise capacity were more likely to be female (55.38% vs 42.62%); to have comorbidities such as diabetes (23.16% vs 9.61%) and hypertension (59.43% vs 44.05%); and to have abnormal ETT findings such as chest pain on the treadmill (12.09% vs 7.63%), abnormal heart rate recovery (82.74% vs 64.13%), and abnormal chronotropic index (32.89% vs 12.20%). In multivariable analysis, including other ETT variables, lower exercise capacity (<85% of predicted) was associated with increased risk of myocardial infarction (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.55-3.60), unstable angina (HR, 2.39; 95% CI, 1.78-3.21), coronary revascularization (HR, 1.75; 95% CI, 1.46- 2.08), and all-cause mortality (HR, 2.90; 95% CI, 1.88-4.47) compared with exercise capacity greater than 100% of predicted.

CONCLUSION

Adjusting for patient characteristics and other ETT variables, reduced exercise capacity was associated with both nonfatal cardiovascular events and mortality in patients referred for ETT.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colorado 80204, USA. Pamela.Peterson@uchsc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18227364

Citation

Peterson, Pamela N., et al. "Association of Exercise Capacity On Treadmill With Future Cardiac Events in Patients Referred for Exercise Testing." Archives of Internal Medicine, vol. 168, no. 2, 2008, pp. 174-9.
Peterson PN, Magid DJ, Ross C, et al. Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. Arch Intern Med. 2008;168(2):174-9.
Peterson, P. N., Magid, D. J., Ross, C., Ho, P. M., Rumsfeld, J. S., Lauer, M. S., Lyons, E. E., Smith, S. S., & Masoudi, F. A. (2008). Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. Archives of Internal Medicine, 168(2), 174-9. https://doi.org/10.1001/archinternmed.2007.68
Peterson PN, et al. Association of Exercise Capacity On Treadmill With Future Cardiac Events in Patients Referred for Exercise Testing. Arch Intern Med. 2008 Jan 28;168(2):174-9. PubMed PMID: 18227364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. AU - Peterson,Pamela N, AU - Magid,David J, AU - Ross,Colleen, AU - Ho,P Michael, AU - Rumsfeld,John S, AU - Lauer,Michael S, AU - Lyons,Ella E, AU - Smith,Scott S, AU - Masoudi,Frederick A, PY - 2008/1/30/pubmed PY - 2008/3/1/medline PY - 2008/1/30/entrez SP - 174 EP - 9 JF - Archives of internal medicine JO - Arch Intern Med VL - 168 IS - 2 N2 - BACKGROUND: Little is known about the association between exercise capacity and nonfatal cardiac events in patients referred for exercise treadmill testing (ETT). Our objective was to determine the prognostic importance of exercise capacity for nonfatal cardiac events in a clinical population. METHODS: A cohort study was performed of 9191 patients referred for ETT. Median follow-up was 2.7 years. Exercise capacity was quantified as the proportion of age- and sex-predicted metabolic equivalents achieved and categorized as less than 85%, 85% to 100%, and greater than 100%. Individual primary outcomes were myocardial infarction, unstable angina, and coronary revascularization. All-cause mortality was a secondary outcome. RESULTS: Patients with lower exercise capacity were more likely to be female (55.38% vs 42.62%); to have comorbidities such as diabetes (23.16% vs 9.61%) and hypertension (59.43% vs 44.05%); and to have abnormal ETT findings such as chest pain on the treadmill (12.09% vs 7.63%), abnormal heart rate recovery (82.74% vs 64.13%), and abnormal chronotropic index (32.89% vs 12.20%). In multivariable analysis, including other ETT variables, lower exercise capacity (<85% of predicted) was associated with increased risk of myocardial infarction (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.55-3.60), unstable angina (HR, 2.39; 95% CI, 1.78-3.21), coronary revascularization (HR, 1.75; 95% CI, 1.46- 2.08), and all-cause mortality (HR, 2.90; 95% CI, 1.88-4.47) compared with exercise capacity greater than 100% of predicted. CONCLUSION: Adjusting for patient characteristics and other ETT variables, reduced exercise capacity was associated with both nonfatal cardiovascular events and mortality in patients referred for ETT. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/18227364/Association_of_exercise_capacity_on_treadmill_with_future_cardiac_events_in_patients_referred_for_exercise_testing_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2007.68 DB - PRIME DP - Unbound Medicine ER -