Prognostic value of estimated functional capacity incremental to cardiac biomarkers in stable cardiac patients

Background-few studies have investigated functional capacity self-assessment tools in either prediction of future major adverse cardiac outcomes beyond all-cause mortality or direct comparisons with clinically available biomarkers. methods and results-we estimated functional capacity using the duke activity status index (dasi) questionnaire in 8987 sequential stable patients without acute coronary syndrome who were undergoing elective diagnostic coronary angiography with 3-year follow-up of major adverse cardiac events (death,nonfatal myocardial infarction,or stroke). a low dasi score provided independent prediction of a 4.8-fold increase in future risk of incident major adverse cardiac events at 3 years (quartiles 1 versus 4 hazard ratio [95% ci] 4.76 [4.03 to 5.61],p<0.001),and a 3.8-fold increased risk after adjusting for traditional risk factors (3.77 [3.15 to 4.51],p<0.001). the prognostic value of the dasi score was evident in both primary and secondary prevention cohorts,with and without heart failure,as well as high and low c-reactive protein and b-type natriuretic peptide levels. the dasi score reclassified 15% of patients (p<0.001) beyond traditional risk factors in predicting future mace. conclusion-a simple self-assessment tool of functional capacity in stable patients undergoing elective diagnostic cardiac evaluation provides independent and incremental prognostic value for prediction of both significant coronary angiographic disease and long-term adverse clinical events. © 2014 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.