Peak aerobic capacity predicts prognosis in patients with coronary heart disease

Background 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. Methods We studied 2,812 patients with CHD between mortality served as end points. Results 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 . kg(-1). min(-1) increase in peak Vo(2) associated with an approximate 15% decrease in risk of death. Among men, a peak Vo(2) (mL . kg(-1). min(-1)) below similar to 15 was associated with the highest risk, whereas a peak Vo(2) above similar to 19 was associated with a low rate and risk for annual all-cause mortality. Among women, a peak Vo(2) below similar to 12 was associated with the highest risk, whereas a peak Vo(2) above similar to 16.5 was associated with the lowest rate and risk for annual all-cause mortality. Conclusions In men and women with CHD, peak Vo(2) remains an independent predictor of all-cause and cardiovascular-specific mortality.