Peak aerobic capacity predicts prognosis in patients with coronary heart disease

BackgroundIt is unknown if contemporary preventive treatments such as statins or primary percutaneous coronary intervention in patients with coronary heart disease (CHD) have rendered obsolete the use of measured exercise capacity for assessment of future risk and prognosis. Using a sample of patients from 2 clinical sites, most of whom were taking β-blockade, antiplatelet, and statin therapy, we hypothesized that peak oxygen consumption (Vo2) would remain a strong and independent predictor of all-cause and cardiovascular-specific mortality in men and women with CHD.MethodsWe studied 2,812 patients with CHD between 1996 and 2004. All-cause and cardiovascular disease–specific mortality served as end points.ResultsIn all men and women and in a subgroup of patients following evidence-based care, peak Vo2 remained a strong predictor of all-cause death, with every 1 mL·kg−1·min−1 increase in peak Vo2 associated with an approximate 15% decrease in risk of death. Among men, a peak Vo2 (mL·kg−1·min−1) below ∼15 was associated with the highest risk, whereas a peak Vo2 above ∼19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak Vo2 below ∼12 was associated with the highest risk, whereas a peak Vo2 above ∼16.5 was associated with the lowest rate and risk for annual all-cause mortality.ConclusionsIn men and women with CHD, peak Vo2 remains an independent predictor of all-cause and cardiovascular-specific mortality.