Stress recovery index for risk stratification of asymptomatic patients following coronary bypass surgery

Riccardo Bigi, Dario Gregori, Laura Cortigiani, Paola Colombo, Cesare Fiorentini

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To prospectively assess the prognostic value of the stress recovery index (SRI) following coronary bypass surgery. Design and patients: Two hundred seventy-eight patients who had undergone coronary bypass surgery and participated in a secondary prevention program were exercise tested and prospectively followed up for a median of 36 months. Cardiac death, nonfatal infarction, and need for further revascularization were target end points. SRI, defined as the difference in absolute values between the area of heart rate-adjusted ST-segment depression during exercise and recovery, was derived in all. Clinical data, resting ejection fraction, and exercise testing data of patients were entered into a sequential Cox model; SRI was entered last. Model validation was performed by bootstrap adjusted by the degree of optimism in estimates. Survival curves were set up using Kaplan-Meier method and compared by the log-rank test. Results: SRI was the only significant and independent prognostic indicator (hazard ratio, 0.68; 95% confidence interval, 0.53 to 0.89) and increased the prognostic power of the model on top of clinical and exercise testing variables, as demonstrated by the significant (p = 0.01) increase of the area under the receiver operating characteristic curve of the risk function. Survival analysis showed ascending SRI quartiles to identify a significant (p = 0.001) increase in event-free survival. Conclusions: SRI is of value in predicting outcome after coronary bypass surgery and provides additional prognostic information over clinical and exercise testing data.

Original languageEnglish
Pages (from-to)42-47
Number of pages6
JournalChest
Volume128
Issue number1
DOIs
Publication statusPublished - Jul 2005

Fingerprint

Exercise
Survival Analysis
Secondary Prevention
Proportional Hazards Models
ROC Curve
Infarction
Disease-Free Survival
Heart Rate
Confidence Intervals
Survival

Keywords

  • Bypass surgery
  • Coronary artery disease exercise
  • ECG
  • Risk stratification
  • Testing

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Stress recovery index for risk stratification of asymptomatic patients following coronary bypass surgery. / Bigi, Riccardo; Gregori, Dario; Cortigiani, Laura; Colombo, Paola; Fiorentini, Cesare.

In: Chest, Vol. 128, No. 1, 07.2005, p. 42-47.

Research output: Contribution to journalArticle

Bigi, Riccardo ; Gregori, Dario ; Cortigiani, Laura ; Colombo, Paola ; Fiorentini, Cesare. / Stress recovery index for risk stratification of asymptomatic patients following coronary bypass surgery. In: Chest. 2005 ; Vol. 128, No. 1. pp. 42-47.
@article{26aa6b2c8d9241ce9dc82b8b00bf777a,
title = "Stress recovery index for risk stratification of asymptomatic patients following coronary bypass surgery",
abstract = "Objective: To prospectively assess the prognostic value of the stress recovery index (SRI) following coronary bypass surgery. Design and patients: Two hundred seventy-eight patients who had undergone coronary bypass surgery and participated in a secondary prevention program were exercise tested and prospectively followed up for a median of 36 months. Cardiac death, nonfatal infarction, and need for further revascularization were target end points. SRI, defined as the difference in absolute values between the area of heart rate-adjusted ST-segment depression during exercise and recovery, was derived in all. Clinical data, resting ejection fraction, and exercise testing data of patients were entered into a sequential Cox model; SRI was entered last. Model validation was performed by bootstrap adjusted by the degree of optimism in estimates. Survival curves were set up using Kaplan-Meier method and compared by the log-rank test. Results: SRI was the only significant and independent prognostic indicator (hazard ratio, 0.68; 95{\%} confidence interval, 0.53 to 0.89) and increased the prognostic power of the model on top of clinical and exercise testing variables, as demonstrated by the significant (p = 0.01) increase of the area under the receiver operating characteristic curve of the risk function. Survival analysis showed ascending SRI quartiles to identify a significant (p = 0.001) increase in event-free survival. Conclusions: SRI is of value in predicting outcome after coronary bypass surgery and provides additional prognostic information over clinical and exercise testing data.",
keywords = "Bypass surgery, Coronary artery disease exercise, ECG, Risk stratification, Testing",
author = "Riccardo Bigi and Dario Gregori and Laura Cortigiani and Paola Colombo and Cesare Fiorentini",
year = "2005",
month = "7",
doi = "10.1378/chest.128.1.42",
language = "English",
volume = "128",
pages = "42--47",
journal = "Chest",
issn = "0012-3692",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Stress recovery index for risk stratification of asymptomatic patients following coronary bypass surgery

AU - Bigi, Riccardo

AU - Gregori, Dario

AU - Cortigiani, Laura

AU - Colombo, Paola

AU - Fiorentini, Cesare

PY - 2005/7

Y1 - 2005/7

N2 - Objective: To prospectively assess the prognostic value of the stress recovery index (SRI) following coronary bypass surgery. Design and patients: Two hundred seventy-eight patients who had undergone coronary bypass surgery and participated in a secondary prevention program were exercise tested and prospectively followed up for a median of 36 months. Cardiac death, nonfatal infarction, and need for further revascularization were target end points. SRI, defined as the difference in absolute values between the area of heart rate-adjusted ST-segment depression during exercise and recovery, was derived in all. Clinical data, resting ejection fraction, and exercise testing data of patients were entered into a sequential Cox model; SRI was entered last. Model validation was performed by bootstrap adjusted by the degree of optimism in estimates. Survival curves were set up using Kaplan-Meier method and compared by the log-rank test. Results: SRI was the only significant and independent prognostic indicator (hazard ratio, 0.68; 95% confidence interval, 0.53 to 0.89) and increased the prognostic power of the model on top of clinical and exercise testing variables, as demonstrated by the significant (p = 0.01) increase of the area under the receiver operating characteristic curve of the risk function. Survival analysis showed ascending SRI quartiles to identify a significant (p = 0.001) increase in event-free survival. Conclusions: SRI is of value in predicting outcome after coronary bypass surgery and provides additional prognostic information over clinical and exercise testing data.

AB - Objective: To prospectively assess the prognostic value of the stress recovery index (SRI) following coronary bypass surgery. Design and patients: Two hundred seventy-eight patients who had undergone coronary bypass surgery and participated in a secondary prevention program were exercise tested and prospectively followed up for a median of 36 months. Cardiac death, nonfatal infarction, and need for further revascularization were target end points. SRI, defined as the difference in absolute values between the area of heart rate-adjusted ST-segment depression during exercise and recovery, was derived in all. Clinical data, resting ejection fraction, and exercise testing data of patients were entered into a sequential Cox model; SRI was entered last. Model validation was performed by bootstrap adjusted by the degree of optimism in estimates. Survival curves were set up using Kaplan-Meier method and compared by the log-rank test. Results: SRI was the only significant and independent prognostic indicator (hazard ratio, 0.68; 95% confidence interval, 0.53 to 0.89) and increased the prognostic power of the model on top of clinical and exercise testing variables, as demonstrated by the significant (p = 0.01) increase of the area under the receiver operating characteristic curve of the risk function. Survival analysis showed ascending SRI quartiles to identify a significant (p = 0.001) increase in event-free survival. Conclusions: SRI is of value in predicting outcome after coronary bypass surgery and provides additional prognostic information over clinical and exercise testing data.

KW - Bypass surgery

KW - Coronary artery disease exercise

KW - ECG

KW - Risk stratification

KW - Testing

UR - http://www.scopus.com/inward/record.url?scp=22244482790&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=22244482790&partnerID=8YFLogxK

U2 - 10.1378/chest.128.1.42

DO - 10.1378/chest.128.1.42

M3 - Article

VL - 128

SP - 42

EP - 47

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -