Keteyian Steven J, Brawner Clinton A, Savage Patrick D, Ehrman Jonathan K, Schairer John, Divine George, Aldred Heather, Ophaug Kristin, Ades Philip A
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Am Heart J. 2008 Aug;156(2):292-300. doi: 10.1016/j.ahj.2008.03.017. Epub 2008 May 22.
It 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 beta-blockade, antiplatelet, and statin therapy, we hypothesized that peak oxygen consumption (Vo(2)) would remain a strong and independent predictor of all-cause and cardiovascular-specific mortality in men and women with CHD.
We studied 2,812 patients with CHD between 1996 and 2004. All-cause and cardiovascular disease-specific mortality served as end points.
In all men and women and in a subgroup of patients following evidence-based care, peak Vo(2) remained a strong predictor of all-cause death, with every 1 mL x kg(-1) x min(-1) increase in peak Vo(2) associated with an approximate 15% decrease in risk of death. Among men, a peak Vo(2) (mL x kg(-1) x min(-1)) below approximately 15 was associated with the highest risk, whereas a peak Vo(2) above approximately 19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak Vo(2) below approximately 12 was associated with the highest risk, whereas a peak Vo(2) above approximately 16.5 was associated with the lowest rate and risk for annual all-cause mortality.
In men and women with CHD, peak Vo(2) remains an independent predictor of all-cause and cardiovascular-specific mortality.
目前尚不清楚当代预防性治疗措施，如他汀类药物治疗或对冠心病（CHD）患者进行直接经皮冠状动脉介入治疗，是否已使通过测量运动能力来评估未来风险和预后的方法过时。我们以来自2个临床地点的患者为样本，其中大多数患者正在接受β受体阻滞剂、抗血小板和他汀类药物治疗，我们假设峰值耗氧量（Vo₂）仍将是冠心病男性和女性全因死亡率及心血管疾病特异性死亡率的强有力且独立的预测指标。
我们研究了1996年至2004年间的2812例冠心病患者。全因死亡率和心血管疾病特异性死亡率作为终点指标。
在所有男性和女性以及遵循循证治疗的患者亚组中，峰值Vo₂仍然是全因死亡的强有力预测指标，峰值Vo₂每增加1 mL·kg⁻¹·min⁻¹，死亡风险约降低15%。在男性中，峰值Vo₂低于约15 mL·kg⁻¹·min⁻¹与最高风险相关，而峰值Vo₂高于约19 mL·kg⁻¹·min⁻¹与较低的年度全因死亡率及风险相关。在女性中，峰值Vo₂低于约12 mL·kg⁻¹·min⁻¹与最高风险相关，而峰值Vo₂高于约16.5 mL·kg⁻¹·min⁻¹与最低的年度全因死亡率及风险相关。
在冠心病男性和女性中，峰值Vo₂仍然是全因死亡率及心血管疾病特异性死亡率的独立预测指标。
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