Ghayoumi Afshin, Raxwal Vinod, Cho Shaun, Myers Jonathan, Chun Sung, Froelicher Victor F
Stanford University Medical Center, Calif, USA.
J Cardiopulm Rehabil. 2002 Nov-Dec;22(6):399-407. doi: 10.1097/00008483-200211000-00003.
The authors evaluate the prognostic value of treadmill testing in a large consecutive series of patients with chronic coronary artery disease. Exercise testing is widely performed, but analyses of the prognostic value of test results have largely concentrated on patients referred for the diagnosis of coronary artery disease, patients after an acute coronary event or procedure, or patients with congestive heart failure.
All patients referred for evaluation at two university-affiliated Veterans Affairs Medical Centers who underwent exercise treadmill tests for clinical indications between 1987 and 2000 were determined to be dead or alive using the Social Security Death Index after a mean 5.8-year follow-up. Patients without established heart disease and those with congestive heart failure were excluded, leaving the target population of those with a history myocardial infarction or coronary intervention. Clinical and exercise test variables were collected prospectively according to standard definitions; testing and data management were performed in a standardized fashion using a computer-assisted protocol. All-cause mortality was used as the endpoint for follow-up. Standard survival analysis was performed including Kaplan Meier curves and the Cox Hazard Model.
Of the 1,473 patients with coronary artery disease who had exercise testing, 273 (19%) patients had a revascularization procedure (Revascularization group); 813 (55%) had a history of myocardial infarction, diagnostic Q waves (MI group), or both; and 387 (26%) had a history of myocardial infarction or Q wave and revascularization (Combined group). Mean age of the patients was 61.8 +/- 9 years. A total of 401 deaths occurred during a mean follow-up of 5.8 years with an annual mortality rate of 4.5%. Only two variables, age and maximal exercise capacity, were independently and statistically associated with time to death in all three groups and were the strongest predictors of all cause mortality.
A simple score based on METs, age, and history of myocardial infarction or diagnostic Q waves can stratify prognosis in patients with chronic coronary artery disease. The score enabled the identification of a group at low risk (32% of the cohort) with an annual mortality rate of 2%, a group at intermediate risk (42% of the cohort) with an annual mortality rate of about 4%, and a group at high risk (26% of the cohort) with an average annual mortality rate of approximately 7%.
作者评估平板运动试验在一大组连续性慢性冠状动脉疾病患者中的预后价值。运动试验应用广泛，但对试验结果预后价值的分析主要集中于因诊断冠状动脉疾病而转诊的患者、急性冠状动脉事件或手术后的患者或充血性心力衰竭患者。
1987年至2000年间，两所大学附属医院退伍军人事务医疗中心因临床指征接受运动平板试验评估的所有患者，在平均5.8年的随访后，通过社会保障死亡指数确定其死亡或存活情况。排除无确诊心脏病的患者和充血性心力衰竭患者，留下有心肌梗死或冠状动脉介入史的目标人群。根据标准定义前瞻性收集临床和运动试验变量；使用计算机辅助方案以标准化方式进行检测和数据管理。全因死亡率用作随访终点。进行标准生存分析，包括Kaplan-Meier曲线和Cox风险模型。
在1473例接受运动试验的冠状动脉疾病患者中，273例（19%）患者接受了血运重建术（血运重建组）；813例（55%）有心肌梗死病史、诊断性Q波（心肌梗死组）或两者兼有；387例（26%）有心肌梗死或Q波病史及血运重建史（联合组）。患者的平均年龄为61.8±9岁。在平均5.8年的随访期间，共发生401例死亡，年死亡率为4.5%。在所有三组中，只有两个变量，即年龄和最大运动能力，与死亡时间独立且具有统计学关联，并且是全因死亡率的最强预测因素。
基于代谢当量、年龄以及心肌梗死或诊断性Q波病史的简单评分可对慢性冠状动脉疾病患者的预后进行分层。该评分能够识别出低风险组（队列的32%），其年死亡率为2%；中风险组（队列的42%），年死亡率约为4%；高风险组（队列的26%），平均年死亡率约为7%。
