Each 1 mL·kg−1·min−1 higher V̇O2peak was associated with a 7% lower MACE risk in men (HR 0.93; 95% CI 0.92-0.95) and 5% lower risk in women (HR 0.95; 95% CI 0.91-0.99) with CAD.
Cohort (n=1,651)
Is higher V̇O2peak associated with a reduced risk of MACE in patients with CAD undergoing cardiac rehabilitation?
Higher V̇O2peak is strongly associated with a lower risk of MACE in both men and women with CAD undergoing cardiac rehabilitation, supporting its use as a prognostic marker.
Effect estimate: HR 0.93 (men), HR 0.95 (women) per 1 mL/kg/min increase (95% CI 0.92-0.95 (men), 0.91-0.99 (women))
Abstract Aims To present sex-specific reference data for peak oxygen uptake (V̇O2peak) in Norwegian patients with coronary artery disease (CAD) undergoing cardiac rehabilitation and examine its association with major adverse cardiovascular events (MACE). Methods We retrospectively analysed treadmill cardiopulmonary exercise test (CPET) data from 1,651 CAD patients (21% women; mean (SD) age 61 (9) years) attending inpatient cardiac rehabilitation (2004–2022). Patients were categorized by index event: myocardial infarction (MI), coronary artery bypass grafting, or percutaneous coronary intervention/pharmacologically treated CAD. Age-, sex-, and diagnosis-specific V̇O2peak reference data were generated. Associations between V̇O2peak and a combined MACE endpoint (all-cause mortality, acute coronary syndrome, stroke, or heart failure) were assessed using Cox proportional hazards models including natural cubic splines for assessing non-linear patterns. Results Men had higher V̇O2peak than women (mean (SD) 26.9 (6.7) vs. 23.2 (5.3) mL·kg−1·min−1; p 0.001). V̇O2peak was on average 2.5 and 1.7 mL·kg−1·min−1 lower per decade of age in men and women, respectively. Patients with a previous MI had the highest V̇O2peak, followed by CABG and PCI/CAD (p 0.001). During 7,880 person-years, 510 patients (36%) experienced MACE. Each 1 mL·kg−1·min−1 higher V̇O2peak was associated with a 7% lower MACE risk (HR 95 % CI; 0.93 0.92-0.95) in men and 5% (HR 95 % CI; 0.95 0.91-0.99) in women. Patients in the highest cardiorespiratory fitness quartile had a 55% lower risk compared to the lowest quartile. Associations were consistent across CAD subcategories. Sex-specific natural cubic spline models revealed inverse, non-linear associations. Conclusion This study provides novel sex- and diagnosis-specific V̇O2peak reference values for Norwegian CAD patients and confirms V̇O2peak as a strong prognostic marker, supporting its integration into routine secondary prevention and individualized care.
Svenningsen et al. (Tue,) conducted a cohort in Coronary artery disease (n=1,651). Peak oxygen uptake (V̇O2peak) vs. Lower V̇O2peak was evaluated on Combined MACE (all-cause mortality, acute coronary syndrome, stroke, or heart failure) (HR 0.93 (men), HR 0.95 (women) per 1 mL/kg/min increase, 95% CI 0.92-0.95 (men), 0.91-0.99 (women)). Each 1 mL·kg−1·min−1 higher V̇O2peak was associated with a 7% lower MACE risk in men (HR 0.93; 95% CI 0.92-0.95) and 5% lower risk in women (HR 0.95; 95% CI 0.91-0.99) with CAD.