Key result
Nomogram combining E/e', age, HbA1c, and eGFR predicts declining exercise tolerance post-PCI with ~0.77 AUC.
Why the study?
Data from cardiopulmonary exercise testing to assess exercise capacity in patients with acute myocardial infarction after percutaneous coronary intervention are scarce.
What are the predictors of reduced exercise tolerance measured by early CPET in patients with AMI after PCI, and does reduced tolerance predict clinical outcomes?
Observational (n=275)
What are the predictors of reduced exercise tolerance measured by early CPET in patients with AMI after PCI, and does reduced tolerance predict clinical outcomes?
Effect estimate: AUC 0.771 (95% CI 0.710-0.832)
Early CPET within 1 week after PCI in AMI patients is feasible, and a nomogram based on age, E/e', HbA1c, and eGFR can predict reduced exercise tolerance, which is associated with worse 24-month clinical outcomes.
Background: Early cardiopulmonary exercise test (CPET) may predict the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, data from CPET to assess the exercise capacity of patients with AMI PCI are still scarce. This study aimed to evaluate the safety of the CPET and assess the predictors and clinical influence of exercise capacity measured by CPET in patients with AMI within 1 week after PCI. Methods: peak, patients were divided into a normal exercise tolerance group and a reduced exercise tolerance group. The general clinical conditions were compared between the 2 groups to investigate the safety of CPET and the influencing factors of exercise tolerance. A nomogram model for predicting patients' exercise capacity was further developed. Clinical outcomes were recorded. Results: The median time of CPET in all patients was 5 days after PCI. Among the 275 patients, exercise tolerance decreased in 90 cases (32.72%). Multivariate logic analysis showed that E/e', age, glycosylated hemoglobin, and estimated glomerular filtration rate (eGFR) were independent predictors of early exercise capacity reduction in these patients. Utilizing the correlation coefficients from pre-assessment clinical and CPET indicators within the logistic regression framework, we constructed a nomogram model to forecast the diminishing exercise tolerance in AMI patients. The predictive accuracy of this model, as indicated by a C-index of 0.771 and an area under the receiver operating characteristic (ROC) curve of 0.771 (95% CI: 0.710-0.832), demonstrates its potential as a robust tool in clinical settings. During a follow-up of 24 months, the incidence of clinical outcomes in patients with low exercise tolerance was significantly higher than that in patients with normal exercise tolerance, among which all-cause mortality and reinfarction were statistically different (P=0.009 and P=0.043). Conclusions: The reduced exercise capacity in patients with AMI after initial PCI is related to age, diastolic dysfunction, renal function, and blood glucose control, which may lead to poor clinical prognosis. The nomogram prediction model performed well in predicting the declining exercise tolerance of patients with AMI.
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Du et al. (2023) conducted an observational in Acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) (n=275). Nomogram prediction model was evaluated on Predictive accuracy of the nomogram model for diminishing exercise tolerance (AUC 0.771, 95% CI 0.710-0.832). A nomogram model incorporating E/e', age, glycosylated hemoglobin, and eGFR accurately predicted declining exercise tolerance in AMI patients after PCI (AUC 0.771; 95% CI 0.710-0.832).
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