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Few studies have investigated self-assessed functional capacity in prediction of future major adverse cardiac outcomes beyond all-cause mortality, or upon adjustments to traditional risk factors and biomarkers.
We estimated functional capacity using the Duke Activity Status Index (DASI), a self-administered functional assessment tool comprised of 12 questions, in 8,979 sequential stable patients without acute coronary syndrome who underwent elective diagnostic coronary angiography with adjudicated 3-year outcomes of major adverse cardiac events (MACE=death, non-fatal myocardial infarction, stroke).
In our study cohort (mean age 64±11 years, 68% male), median DASI score was 38.2 (IQR 24.2-50.7). After adjusting for traditional risk factors and hsCRP, DASI score predicted angiographic evidence of significant (≥50% stenosis) coronary artery disease (Quartiles 1 vs 4, odds ratio 2.24 [95%CI 1.84-2.72], p<0.001). Furthermore, DASI score predicted a 4.8-fold increase MACE risk (unadjusted Hazard ratio [95%CI] 4.76 [4.3-5.61], p<0.001, Figure) and a 2.3-fold increased risk after adjusting for traditional risk factors and hsCRP (2.29 [1.78-2.95], p<0.001), while reclassified risk profile in 12% of subjects (p<0.01).
Self-assessment of functional capacity in stable cardiac patients provides independent and incremental prognostic value for prediction of significant coronary angiographic disease and long-term adverse clinical events.
West, Room 3010
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: State-of-the-Art Evaluation and Management of SIHD: Past, Present, Future
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 916-4
- 2013 American College of Cardiology Foundation