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Titolo:
Clinical and exercise test predictors of all-cause mortality - Results from > 6,000 consecutive referred male patients
Autore:
Prakash, M; Myers, J; Froelicher, VF; Marcus, R; Do, D; Kalisetti, D; Atwood, JE;
Indirizzi:
Vet Affairs Palo Alto Hlth Care Syst, Cardiol Div 111C, Palo Alto, CA 94304 USA Vet Affairs Palo Alto Hlth Care Syst Palo Alto CA USA 94304 CA 94304 USA Univ Calif Irvine, Irvine, CA 92717 USA Univ Calif Irvine Irvine CA USA 92717 Calif Irvine, Irvine, CA 92717 USA Stanford Univ, Div Cardiovasc Med, Med Ctr, Stanford, CA 94305 USA Stanford Univ Stanford CA USA 94305 Med, Med Ctr, Stanford, CA 94305 USA
Titolo Testata:
CHEST
fascicolo: 3, volume: 120, anno: 2001,
pagine: 1003 - 1013
SICI:
0012-3692(200109)120:3<1003:CAETPO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; PRACTICE GUIDELINES COMMITTEE; AMERICAN-HEART-ASSOCIATION; MEDICALLY TREATED PATIENTS; PROGNOSTIC VALUE; CARDIOVASCULAR DEATH; ACC/AHA GUIDELINES; TASK-FORCE; MEN; SCORE;
Keywords:
coronary artery disease; exercise testing; prognosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Froelicher, VF Vet Affairs Palo Alto Hlth Care Syst, Cardiol Div 111C, 3801 Miranda Ave, Palo Alto, CA 94304 USA Vet Affairs Palo Alto Hlth Care Syst3801 Miranda Ave Palo Alto CA USA 94304
Citazione:
M. Prakash et al., "Clinical and exercise test predictors of all-cause mortality - Results from > 6,000 consecutive referred male patients", CHEST, 120(3), 2001, pp. 1003-1013

Abstract

Objective: To report the prevalence of abnormal treadmill test responses and their association with mortality in a large consecutive series of patients referred for standard exercise tests, with testing performed and reported in a standardized fashion. Background: Exercise testing is widely performed, but few databases exist of large numbers of consecutive tests performed on patients referred for routine clinical purposes using standardized methods. Even fewer of the available databases have information regarding all-cause mortality as an outcome. Methods: All patients referred for evaluation at two university-affiliatedVeterans Affairs medical centers who underwent exercise treadmill testing for clinical indications between 1987 and 2000 were determined to be dead or alive using the Social Security death index after a mean 6.2 years (median, 7 years) of follow-up. Clinical and exercise test variables were collected prospectively according to standard definitions; testing and data management were performed in a standardized fashion using a computer-assisted protocol. All-cause mortality was utilized as the end point for follow-up. Standard survival analysis was performed, including Kaplan-Meier curves and a Cox hazard model. Results: There were 6,213 male patients (mean +/- SD age, 59 +/- 11 years)who underwent standard exercise ECG treadmill testing over the study period with a mean follow-up duration of 6.2 +/- 3.7 years. There were no complications of testing in this clinically referred population, 78% of whom werereferred for chest pain, or risk factors or signs or symptoms of ischemic heart disease. Overlapping thirds had typical angina or history of myocardial infarction (MI). Five hundred seventy-nine patients had prior coronary artery bypass surgery, and 522 patients had a history of congestive heart failure (CHF). Indications for testing were in accordance with published guidelines. Twenty percent died over the follow-up period, for an average annual mortality rate of 2.6%. Cox hazard function chose the following variablesin rank order as independently and significantly associated with time to death: exercise capacity (metabolic equivalents < 5, age > 65 years, historyof CHF, and history of MI. A score based on these variables (summing up the four variables [if yes = 1 point]) classified patients into low-risk, medium-risk, and high-frisk groups. The high-risk group (score greater than orequal to 3) has a hazard ratio of 5.0 (95% confidence interval, 4.7 to 5.3) and a 5-year mortality rate of 31%. Conclusion: This comprehensive analysis provides rates of various abnormalresponses that can be expected in patients referred for exercise testing at a typical medical center. Four simple variables combined as a score powerfully stratified patients according to prognosis.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 08:21:08