Abstract 15189: High Exercise Capacity Attenuates Mortality Risk Associated With Unrevascularized and Revascularized Coronary Artery Disease: The FIT Project
Introduction: The prognostic value of cardiorespiratory fitness in patients with revascularizations has been studied in cardiac rehabilitation settings but not in everyday practice. Furthermore, whether increased exercise capacity changes the prognosis between those with unrevascularized and revascularized coronary artery disease (CAD) is unclear.
Methods: This retrospective cohort study included 12,453 adults with known CAD (70% men, 29% African American, 61 ± 12 years old) who underwent stress testing at a single health system in Detroit, MI between 1991 and 2009 and were followed for 11.8 ± 5 years for all-cause mortality. Patients were categorized according to revascularization status (unrevascularized, PCI, CABG) and METS achieved during stress testing (<6, 6-10, 10-12, >12). Using Cox regression models, we assessed mortality risk adjusted for age, sex, race, obesity, hypertension, hyperlipidemia, smoking, diabetes, atrial fibrillation history as well as cardiovascular and COPD medication use including aspirin, clopidogrel and beta blockers.
Results: There were 4,566 all-cause deaths during follow-up. Those with history of (i) unrevascularized CAD, (ii) PCI and (iii) CABG achieved METS of 6.9 ± 3, 7.7 ± 3, and 6.8 ± 3 and had mortality at mean follow-up of 32%, 22% and 33%, respectively. A marked, inverse association between METS categories and mortality was observed in all CAD groups (Panel 1). In addition, the unrevascularized CAD group had significantly worse prognosis than the PCI and CABG groups only in the METS < 10 and METS < 6 categories, respectively (Panel 2).
Conclusion: Low fitness is a strong predictor of mortality in this cohort of adults with known CAD, regardless of revascularization status. Furthermore, high fitness attenuated the mortality differences seen between those with unrevascularized and revascularized CAD. These results suggest a cardioprotective effect of fitness and reinforce its prognostic value in patients with CAD.
- Cardiorespiratory fitness
- Longitudinal studies
- Coronary artery disease
- Percutaneous coronary intervention
- Myocardial revascularization
- © 2013 by American Heart Association, Inc.