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ESTIMATED FUNCTIONAL CAPACITY BY DUKE ACTIVITY STATUS INDEX RECLASSIFIES CARDIOVASCULAR RISK IN STABLE PATIENTS UNDERGOING ELECTIVE CORONARY EVALUATION
E1165 JACC March 12, 2013 Volume 61, Issue 10
Chronic CAD/Stable Ischemic Heart Disease Estimated Functional Capacity by Duke Activity Status Index Reclassifies Cardiovascular Risk in Stable Patients Undergoing Elective Coronary Evaluation Oral Contributions 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 Authors: Wai Hong Wilson Tang, Yiying Fan, Leslie Cho, Cindy Stevenson, Stephen Ellis, Stanley Hazen, Cleveland Clinic, Cleveland, OH, USA Background: Few studies have investigated self-assessed functional capacity in prediction of future major adverse cardiac outcomes beyond allcause mortality, or upon adjustments to traditional risk factors and biomarkers. Methods: 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). Results: 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). Conclusion: 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.
Chronic CAD/Stable Ischemic Heart Disease Estimated Functional Capacity by Duke Activity Status Index Reclassifies Cardiovascular Risk in Stable Patients Undergoing Elective Coronary Evaluation Oral Contributions 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 Authors: Wai Hong Wilson Tang, Yiying Fan, Leslie Cho, Cindy Stevenson, Stephen Ellis, Stanley Hazen, Cleveland Clinic, Cleveland, OH, USA Background: Few studies have investigated self-assessed functional capacity in prediction of future major adverse cardiac outcomes beyond allcause mortality, or upon adjustments to traditional risk factors and biomarkers. Methods: 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). Results: 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). Conclusion: 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.