Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2024 Apr 1;87(4):414-421. doi: 10.1097/JCMA.0000000000001081. Epub 2024 Mar 6.
Patients who survive an acute myocardial infarction (AMI) have a higher risk of having a major cardiovascular event (MACE). Cardiopulmonary exercise testing (CPET) could develop prognostic stratification and prescribing exercise prescription. Patients after AMI frequently terminate CPET early with submaximal testing results. We aimed to look at the characteristics of patients' predischarge CPET variables after AMI intervention and find potential CPET variables with prognostic value.
Between July 2012 and August 2017, we recruited patients who survived first AMI after primary percutaneous coronary intervention and received predischarge CPET retrospectively in a tertiary medical center of Taiwan. Patients were followed-up on a MACE or administrative censoring occurred (up to 5 years). To identify significant predictors of a MACE, a Cox regression model was used.
One hundred thirteen patients (103 men and 10 women) were studied, with an average age of 58.32 ± 12.49. MACE over 3 months, 2-years, and 5-years was 17.70%, 53.10%, and 62.83%, respectively. The oxygen uptake efficiency slope during the whole during of CPET (OUES 100) divided by body surface area (OUES 100/BSA) was found to be a significant event predictor for MACE at 3-month, 2- and 5-years. Cox regression analysis revealed that those with OUES 100/BSA <0.722 ( p = 0.004), OUES 100/BSA <0.859 ( p = 0.002), and OUES 100/BSA <0.829 ( p = 0.002) had a 7.14-fold, 3.47-fold, and 2.72-fold increased risk of 3-month, 2-year, and 5-year MACE, respectively.
It is critical to identify a submaximal predictor during CPET for patients who survive AMI. Our findings suggested that OUES could be a significant prognostic indicator in patients after first AMI in both the short and long term.
急性心肌梗死（AMI）幸存患者发生主要心血管事件（MACE）的风险较高。心肺运动测试（CPET）可用于进行预后分层和制定运动处方。AMI 后患者经常在亚最大测试结果时提前结束 CPET。我们旨在观察 AMI 干预后患者出院前 CPET 变量的特征，并找到具有预后价值的潜在 CPET 变量。
2012 年 7 月至 2017 年 8 月，我们在台湾的一家三级医疗中心回顾性招募了接受初次经皮冠状动脉介入治疗后幸存的首次 AMI 并接受出院前 CPET 的患者。对患者进行了 MACE 随访或行政随访（最长 5 年）。为了确定 MACE 的显著预测因素，我们使用了 Cox 回归模型。
共纳入 113 例患者（103 名男性和 10 名女性），平均年龄为 58.32±12.49 岁。3 个月、2 年和 5 年时 MACE 发生率分别为 17.70%、53.10%和 62.83%。CPET 全过程的摄氧量效率斜率除以体表面积（OUES 100/BSA）被发现是 3 个月、2 年和 5 年时 MACE 的显著事件预测因素。Cox 回归分析显示，OUES 100/BSA <0.722（p=0.004）、OUES 100/BSA <0.859（p=0.002）和 OUES 100/BSA <0.829（p=0.002）的患者，其 3 个月、2 年和 5 年 MACE 的风险分别增加了 7.14 倍、3.47 倍和 2.72 倍。
识别 AMI 幸存患者 CPET 中的亚最大预测因素非常重要。我们的研究结果表明，在 AMI 后患者的短期和长期内，OUES 可能是一个重要的预后指标。
