High level of physical activity preserves the cardioprotective effect of preinfarction angina in elderly patients

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• 作者：Pasquale Abete ; Nicola Ferrara ; Francesco Cacciatore ; Elio Sagnelli ; Maria Manzi ; Vincenzo Carnovale ; Claudio Calabrese ; Domenico de Santis ; Gianluca Testa ; Giancarlo Longobardi ; Claudio Napoli ; Fran
• 关键词：ACC/AHA Scientific Statements ; coronary disease ; electrocardiography ; exercise ; tests
• 刊名：Journal of the American College of Cardiology
• 出版年：2001
• 出版时间：1 November 2001
• 年：2001
• 卷：38
• 期：5
• 页码：1357-1365
• 全文大小：134 K

文摘

OBJECTIVES

The study investigated the effects of physical activity on preinfarction angina, a clinical equivalent of ischemic preconditioning (PC), in adult and elderly patients with acute myocardial infarction (AMI).

BACKGROUND

Preinfarction angina seems to confer protection against in-hospital mortality in adult but not in elderly patients. However, it has been experimentally demonstrated that exercise training restores the protective effect of PC in the aging heart.

METHODS

We retrospectively verified whether physical activity preserved the protective effect of preinfarction angina against in-hospital mortality in 557 elderly patients with AMI. Physical activity was quantified according to the Physical Activity Scale for the Elderly (PASE).

RESULTS

In-hospital mortality was 22.2 % in elderly patients with preinfarction angina and 27.2 % in those without (p = 0.20). When the PASE score was stratified in quartiles (0 to 40, 41 to 56, 57 to 90, >90), a high score was strongly associated with reduced in-hospital mortality (30.8 % , 32.2 % , 17.2 % and 15.3 % , respectively, p < 0.001 for trend). Interestingly, a high level of physical activity reduced in-hospital mortality in elderly patients with preinfarction angina (35.7 % , 35.4 % , 12.3 % and 4.23 % , respectively, p < 0.001 for trend) but not in those without (23.0 % , 27.2 % , 26.0 % and 35.0 % , respectively, P = 0.35 for trend). Accordingly, the protective role of preinfarction angina on in-hospital mortality was present only in elderly patients showing a high level of physical activity (adjusted odds ratio, 0.09; 95 % confidence interval, 0.01 to 0.57; p < 0.05).

CONCLUSIONS

Physical activity and not preinfarction angina protects against in-hospital mortality in elderly patients with myocardial infarction. Nevertheless, the protective effect of preinfarction angina is preserved in elderly patients with a high level of physical activity.