In premature CAD patients, achieving >80% theoretical peak VO₂ post-rehabilitation was linked to 170-day longer event-free survival and HR 0.75 per 10% VO₂ increase.
Does achieving a %VO₂max > 80% after cardiac rehabilitation reduce recurrent MACE in individuals with premature CAD?
Achieving a %VO₂max > 80% after cardiac rehabilitation is associated with a significantly lower risk of recurrent MACE in young patients with premature CAD.
Absolute Event Rate: 0% vs 0%
Abstract Background Individuals with premature coronary artery disease (CAD), diagnosed before the age of 45, are active but endure a chronic and aggressive disease. Currently, data on their exercise capacity and its association with cardiovascular outcomes remain limited. Objectives To describe the exercise capacity of individuals with premature CAD using cardiopulmonary exercise testing and to assess its association with major adverse cardiovascular events (MACE). Methods The AFIJI (Appraisal of Risk Factors in Young Ischemic Patients Justifying Aggressive Intervention) prospective cohort enrolls individuals with premature atherosclerotic disease, defined as either type 1 myocardial infarction or ischemic symptoms with obstructive CAD. A dedicated check-up is performed after cardiovascular rehabilitation, including cardiopulmonary exercise testing within three months of the index event. Successful rehabilitation was defined as achieving a percentage of the theoretical peak VO₂ (%VO₂max) greater than 80%, with the theoretical peak calculated using Wasserman’s formula, accounting for age, sex, and weight. The association between %VO₂max and recurrent MACE (cardiovascular death, myocardial infarction, stroke, or revascularization) was evaluated using Kaplan-Meier analysis, restricted mean survival time analysis, and Cox frailty models. Results Among 88 individuals (median age 43 years, median LVEF 55%, 83% male), the median %VO₂max was 65.5% 95% CI 30.1 – 104.9, with values of 67.6% 31.5 – 110.0 in men and 54.4% 21.3 – 83.7 in women. At three years, a %VO₂max 80% was associated with a significantly lower risk of MACE (Figure 1 – Kaplan-Meier analysis). The %VO₂max 80% group had a 169.9-day longer event-free survival compared to the %VO₂max 80% group (p 0.001). The %VO₂max 80% cutoff was associated with a negative predictive value of 100% at 3 years. The area under the curve for %VO₂max was 0.614. After multivariate adjustment for smoking cessation, diabetes, hypertension, and dyslipidemia, %VO₂max remained an independent protective factor against recurrent ischemic events, with a 10% increase in %VO₂max corresponding to an adjusted hazard ratio of 0.75 95% CI 0.56 – 0.99. Conclusion Successful cardiac rehabilitation leading to an improved exercise capacity appears to be a protective factor in a young and active population with premature CAD.Kaplan-Meier analysis
Martin et al. (Sat,) reported a other. In premature CAD patients, achieving >80% theoretical peak VO₂ post-rehabilitation was linked to 170-day longer event-free survival and HR 0.75 per 10% VO₂ increase.