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(Circulation. 2002;106:666.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Prediction of Long-Term Prognosis in 12 169 Men Referred for Cardiac Rehabilitation

Terence Kavanagh, MD, FRCP(C); Donald J. Mertens, MD, MSc; Larry F. Hamm, PhD; Joseph Beyene, PhD; Johanna Kennedy, RN; Paul Corey, PhD; Roy J. Shephard, MD, PhD

From Toronto Rehabilitation Institute (T.K., D.J.M., J.K., R.J.S.), Faculty of Medicine (T.K.), Faculty of Physical and Health Education (T.K., R.J.S.), and Department of Public Health Sciences (J.B., P.C., R.J.S.), University of Toronto, Ontario, Canada; and George Washington University (L.F.H.), Washington, DC.

Correspondence to T. Kavanagh, MD, Marina Cardiac Research Department, 5385 Yonge St, Toronto, ON M2N 5R7, Canada. E-mail terence.kavanagh{at}utoronto.ca

Background— Predicting the risk of cardiac and all-cause death in patients with established coronary heart disease is important in counseling the individual and designing risk-stratified rehabilitation and secondary prevention programs. Cox proportional hazards and Kaplan-Meier survival curves were thus completed on initial assessment data obtained from patients referred to an outpatient cardiac rehabilitation center.

Methods and Results— A single-center prospective observational design took peak cardiorespiratory exercise test data for 12 169 male rehabilitation candidates aged 55.0±9.6 years (7096 myocardial infarctions [MIs], 3077 coronary artery bypass grafts [CABGs], and 1996 documented cases of ischemic heart disease [IHD]). A follow-up of 4 to 29 years (median, 7.9) yielded 107 698 man-years of experience. Entry data were tested for associations with time to cardiac and all-cause death. We recorded 1336 cardiac deaths (953 MI, 225 CABG, and 158 IHD) and 2352 all-cause deaths. A powerful predictor of cardiac and all-cause mortality was measured peak oxygen intake (O_2peak). For the overall sample, values of <15, 15 to 22, and >22 mL/kg per minute yielded respective multivariate adjusted hazard ratios of 1.00, 0.62, and 0.39 for cardiac and 1.00, 0.66, and 0.45 for all-cause deaths. For the separate diagnostic categories, apart from O_2peak, the only other significant predictors of cardiac death common to all 3 were smoking and digoxin, and for all-cause death, age, smoking, digoxin, and diabetes.

Conclusions— Exercise capacity, as determined by direct measurement of O_2peak, exerts a major long-term influence on prognosis in men after MI, CABG, or IHD and can play a valuable role in risk stratification and counseling.

Key Words: exercise • prognosis • coronary disease • survival

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