Prognostic Interplay Between Coronary Artery Calcium Scoring and Cardiorespiratory FItness: The CAC-FIT Study

医学 内科学 心脏病学 代谢当量 四分位间距 危险系数 冠状动脉疾病 心肌梗塞 比例危险模型 心肺适能 人口 血脂异常 心力衰竭 队列 置信区间 疾病 物理疗法 体力活动 环境卫生
作者
Ahmed Ibrahim Ahmed,Jean Michel Saad,Yushui Han,Moath Said Alfawara,Ahmed A. Soliman,Faisal Nabi,William A. Zoghbi,Mouaz H. Al‐Mallah
出处
期刊:Mayo Clinic Proceedings [Elsevier BV]
卷期号:97 (7): 1269-1281 被引量:3
标识
DOI:10.1016/j.mayocp.2022.03.032
摘要

To assess the incremental prognostic role of coronary artery calcium score (CACS) and exercise capacity (EC), two independent prognostic tests in the assessment of patients with coronary artery disease.The cohort consisted of patients who had clinically indicated exercise stress testing and CACS assessment from January 1, 2015, to September 30, 2021, with a median of 27 days between each other. Exercise capacity was defined by peak metabolic equivalents of task (METs) achieved during exercise stress test. The CACS was determined by the Agatston method. Patients were observed from the latest test date to incident major adverse cardiac events (inclusive of all-cause death, nonfatal myocardial infarction, late revascularization, and admission for heart failure).There were a` total of 1932 patients in the study population (mean age, 56±12 years; 42% female, 48% hypertension, 21% diabetes, 48% dyslipidemia). Peak METs below 6 was achieved in 8% of patients, and the median (interquartile range) CACS was 9 (0-203). In multivariable Cox regression models, both CACS (1 unit increase in log CACS: hazard ratio, 1.19; 95% CI, 1.06 to 1.34; P=.003;) and EC (1 unit increase in peak METs: hazard ratio, 0.89; 95% CI, 0.81 to 0.97; P=.01) were independently associated with outcomes. Using CACS+EC added incremental prognostic value over clinical and fitness models (C index increase from 0.68 to 0.75; P=.015). Incident event rates increased across categories of CACS and EC.Our analysis found that CACS and EC have complementary risk-stratifying roles in coronary artery disease.
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