ESC Congress 2026 Abstract · Oct 26, 2026
Maximal work rate after myocardial infarction as a predictor of major adverse cardiovascular events and mortality: a nationwide SWEDEHEART study
By Lonn A, Carlen A, Ekstrom M et al.
Background: Cardiorespiratory fitness (CRF), assessed by cardiopulmonary exercise testing, is an established prognostic marker for adverse health outcomes in patients with cardiovascular disease. However, CRF is rarely assessed in routine clinical practice after myocardial infarction (MI), largely due to limited availability. Maximal work rate achieved during cycle ergometer exercise testing is widely available and may represent a pragmatic surrogate for CRF and a scalable tool for risk stratification after MI. Purpose: To explore the association between estimated maximal work rate after MI and the risk of incident major adverse cardiovascular event (MACE) and all-cause mortality, stratified by sex. Methods: In this nationwide cohort study based on the SWEDEHEART-MI registry, individuals diagnosed with MI between 2016 and 2020 were included. The estimated maximal work rate (Watts) was assessed using cycle ergometer exercise testing with 25 Watts stepwise increase in work rate, prior to exercise-based cardiac rehabilitation. Time on peak work rate was used to estimate maximal work rate. Incident MACE (hospitalisation of MI, stroke, revascularization/angina, heart failure, and CVD-mortality), and all-cause mortality until 2023 were ascertained by linkage to the national patient and cause of death registries. Hazard ratios with 95% confidence intervals (CIs) were estimated using adjusted Cox proportional hazards regression models. Restricted cubic splines with three knots were applied to assess non-linear associations. Results: A total of 15,945 individuals (mean age 63 years, SD 9, 78% men) were included. During a median follow-up of 3.2 years (IQR 2.0 years), 1,334 MACE and 420 deaths occurred. There was a log-curvilinear association with MACE in both sexes. For all-cause mortality, the association was log-linear in men but log-curvilinear in women. Each 10-watt higher maximal work rate was associated with a 6% lower risk of MACE in men and a 17% lower risk in women. Corresponding reductions in all-cause mortality were 18% in men and 33% in women (Figure 1). Conclusions: Higher estimated maximal work rate after MI was independently associated with lower risk of MACE and all-cause mortality, with stronger associations observed in women. These findings support the clinical value of routine assessment of maximal work rate as pragmatic and scalable tool for risk stratification post-MI.Figure 1