Predictive value of cardiopulmonary fitness parameters in the prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

Abstract

Objectives We aimed to determine the predictive value of cardiopulmonary exercise testing (CPX) in the prognosis of patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). Methods We conducted a retrospective study including patients who underwent CPX within 1 year of PCI between September 2012 and October 2017. Patients were followed-up until the occurrence of a major adverse cardiac event (MACE) or administrative censoring (September 2019). A Cox regression model was used to identify significant predictors of a MACE. Model performance was evaluated in terms of discrimination (C-statistic) and calibration (calibration-in-the-large). Results In total, 184 patients were included and followed-up for a median 51 months (interquartile range: 36–67 months) and 32 events occurred. Multivariable analysis revealed that body mass index and Gensini score were significant predictors of a MACE. Four CPX-related variables were found to be predictive of a MACE: premature CPX termination, peak oxygen uptake, heart rate reserve, and ventilatory equivalent for carbon dioxide slope. The final prediction model had a C-statistic of 0.92 and calibration-in-the-large 0.58%. Conclusion CPX-related parameters may have high predictive value for poor outcomes in patients with ACS who undergo PCI, indicating a need for appropriate treatment and timely management.

Predischarge oxygen uptake efficiency slope has short and long-term value in the prognosis of patients after acute myocardial infarction

“…Although 31 participants (27.43%) experienced unbearable symptoms and had to stop the CPET, they all recovered within 5 minutes and had no serious adverse events or complications. Our findings were consistent with those of Niu et al 5 , who discovered that 39.13% of patients discontinued CPET prematurely. 5 Our results indicated the safety and feasibility of AMI patients undergoing CPET in well-prepared clinical settings.…”

“…Notably, we are the first to demonstrate the utility of submaximal CPET variables, particularly OUES, in phase I cardiac rehabilitation as indicators for a 5-year prognosis. Due to the escalating patient numbers and high mortality rates post-AMI without continuous standard treatment, 5 it is critical to identify high-risk patients surviving AMI. CPET, offering noninvasive, objective, and quantifiable assessments of cardiac reserve function and exercise tolerance, holds significant potential for risk stratification and tailored treatment.…”

“…The 2016 European Association for Cardiovascular Prevention and Rehabilitation/American Heart Association scientific statement highlights the prognostic significance of peak VO 2 , VO 2 at ventilator threshold, and the VE/VCO 2 slope in diverse populations. 28 Niu et al 5 discovered that premature CPET termination, peak VO 2 , heart rate reserve, and VE/VCO 2 slope have a high predictive value for poor outcomes in patients with acute coronary syndrome following PCI. However, in their study, the median time from PCI to CPET was 7.27 ± 3.68 months, which was significantly longer than our data (5.70 ± 3.23 days).…”

“…Stress echocardiography requires extensive training and adherence to high interoperator consistency standards. 5 In contrast, cardiopulmonary exercise testing (CPET) excels in providing comprehensive insights into cardiovascular, pulmonary, and musculoskeletal integration, offering valuable assessments of functional aerobic capacity in various populations, both healthy and diseased, making it a gold standard for prognostic stratification. 6,7 Among all CPET indices, maximal oxygen consumption (max VO 2 ) is the most consistent with predicted values in patients with various diseases.…”

Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation

“…This reclassification was associated with a better outcome. Although several studies and meta-analyses have shown that exercise training is associated with a better prognosis [ 31 , 32 , 33 ], few studies have analyzed whether the change in risk categories is associated with prognosis. The proposed risk score could identify no-low risk patients soon after an ACS and add further prognostic information after an exercise training program.…”