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A new score model for mortality prediction in treadmill test
Session:
Comunicações Orais (Sessão 5) - Risco CV, Prevenção e Reabilitação Cardíaca 1 - Foco nos Scores de Risco
Speaker:
Inês Sofia Pereira Oliveira
Congress:
CPC 2022
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Pereira Oliveira; Bruno Bragança; Isabel Cruz; Rafaela Lopes; Joel Monteiro; Joao Azevedo; Paula Pinto; Aurora Andrade
Abstract
<p><strong>Background:</strong> Exercise stress testing is a stablished diagnostic and prognostic tool in cardiovascular (CV) disease patients (pts). Although functional capacity and heart rate (HR) response to exercise are known prognostic factors, its role to stratify high-risk pts is not well defined.</p> <p><strong>Objectives: </strong>To asses the association between functional capacity, HR response to exercise and CV outcomes in pts with coronary artery disease (CAD), in order to develop a score for risk stratification in this population.</p> <p><strong>Methods: </strong>We performed a retrospective analysis of a cohort of 497 consecutive patients with known CAD, who underwent Bruce protocol treadmill testing (TT) between 2009-2010, followed during 9.7±2.7years. We analyzed known cardiovascular risk factors and the available parameters of TT, and their correlation with the occurrence of all-cause mortality during the follow-up. A multivariate binary logistic regression analysis was performed according to Backward Wald method, selecting the clinical variables with highest mortality predictive power. A multiplicative score was developed as the following: Age=Metabolic Equivalent of Task (MET) x DHR. The predictive performance of this model was evaluated using ROC curve analysis.</p> <p><strong>Results: </strong>The variables associated with all-cause mortality during the follow up were age (p<0.001), peak heart rate (p<0.001), metabolic equivalent of task (p<0.001), double product (p=0.003) and heart rate variance between peak and rest (p<0.001). The backwards-Wald logist regression identified Age, heart rate variance and MET as independent risk predictors. The multiplicative model showed association with all cause mortality (p<0.001) and a moderate-high risk prediction capacity using ROC curve analysis (AUC=0.73). Optimal bining identified 24 and 12 as cutoffs for the model. The categorized score retained its prognostic capacity with an AUC of 0.72.</p> <p><strong>Conclusion:</strong> This simple model based on physiological variables drawn from the stress test, predicts long term all-cause mortality in a cohort of high-risk CAD patients. Its simple categorization retains the prognostic value of the model and allows for immediate risk assessment. </p>
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