Submaximal effort tolerance as a predictor of all-cause mortality in patients undergoing cardiac rehabilitation
Submaximal effort tolerance as a predictor of all-cause mortality in patients undergoing cardiac rehabilitation
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DOI：
10.1002/clc.20076
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发表时间：
2007-05-01
影响因子：
2.7
通讯作者：
Kligfield, Paul
中科院分区：
文献类型：
--
作者：
Feuerstadt, Paul;Chai, Andrew;Kligfield, Paul
背景资料：心脏康复期间通常可以获得次极量耐力，但其与潜在转诊诊断相关的预后价值尚不清楚。假设：次极量运动训练期间的跑步机努力能力可预测心脏康复后的全因死亡率。方法：我们连续跟踪了600个病人（450名男性和150名女性，平均年龄65岁），他们被转介到一个为期12周的心脏康复门诊计划; 37%有心肌梗死（MI）病史，44%近期接受过经皮介入治疗（PCI），39%有冠状动脉旁路手术（CABG）史。结果：在平均随访1603 ± 822天期间，有48例死亡。通过多变量考克斯分析，退出MET活性是全因死亡率最重要的预测因子。在该模型中，退出次最大努力耐力每增加1 MET，死亡率降低34%（风险比[HR] 0.66，95%置信区间0.56-0.77），经年龄校正后死亡率降低28%（HR = 0.72，置信区间0.60-0.85）。实体MET水平也有预测价值。亚组分析显示，退出MET的预测价值仅限于近期CABG后和MI患者。没有一个变量预测PCI后死亡，其中死亡率显着低于其他groups.Conclusions：次最大努力耐力在完成心脏康复，并在进入，是一个强大的和年龄无关的预测死亡率的患者最近的CABG或MI没有干预，但不是在最近的PCI后的患者。
Background: Submaximal effort tolerance is routinely available during cardiac rehabilitation, but its prognostic value in relation to underlying referral diagnosis is not known.Hypothesis: Treadmill effort capacity during submaximal exercise training predicts all-cause mortality after cardiac rehabilitation.Methods: We followed 600 consecutive patients (450 men and 150 women, mean age 65 years) who were referred to a 12-week outpatient program of cardiac rehabilitation; 37% had a prior myocardial infarction (MI), 44% had a recent percutaneous intervention (PCI), and 39% had history of coronary artery bypass surgery (CABG).Results: There were 48 deaths during a mean follow-up period of 1603 +/- 822 days. By multivariate Cox analysis, exit MET activity was the most significant predictor of all-cause mortality. In this model, each 1 MET increase in exit submaximal effort tolerance was associated with a 34% decrease in mortality (hazard ratio [HR] 0.66, 95% confidence interval 0.56-0.77) alone and 28% decrease after adjustment for age (HR = 0.72, confidence interval 0.60-0.85). Enty MET level also had predictive value. Subgroup analysis revealed that the predictive value of exit METs was limited to patients after recent CABG and with MI. None of the variables predicted death after PCI, in whom mortality was significantly lower than in the other groups.Conclusions: Submaximal effort tolerance at completion of cardiac rehabilitation, and also at entry, is a strong and age-independent predictor of mortality in patients who have had either recent CABG or MI without intervention, but not in patients after recent PCI.