Impact of pre-admission physical activity on benefits of physiology-guided complete revascularization in older patients with myocardial infarction: insights from the FIRE trial. in European journal of preventive cardiology / Eur J Prev Cardiol. 2024 Sep 6;31(12):1451-1459. doi: 10.1093/eurjpc/zwae069.

2024
AOU San Luigi di Orbassano

Tipo pubblicazione

Randomized Controlled Trial

Autori/Collaboratori (28)Vedi tutti...

Pavasini R
Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy.
Campo G
Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy.
Serenelli M
Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy.

et alii...

Abstract

AIMS: The present analysis from the Functional Assessment in Elderly Myocardial Infarction Patients with Multivessel Disease (FIRE) trial aims to explore the significance of pre-admission physical activity and assess whether the benefits of physiology-guided complete revascularization apply consistently to sedentary and active older patients. METHODS AND RESULTS: Patients aged 75 years or more with myocardial infarction (MI) and multivessel disease were randomized to receive physiology-guided complete revascularization or culprit-only strategy. The primary outcome was a composite of death, MI, stroke, or any revascularization within a year. Secondary endpoints included the composite of cardiovascular death or MI, as well as single components of the primary endpoint. Pre-admission physical activity was categorized into three groups: (i) absent (sedentary), (ii) light, and (iii) vigorous. Among 1445 patients, 692 (48%) were sedentary, whereas 560 (39%) and 193 (13%) performed light and vigorous physical activity, respectively. Patients engaging in light or vigorous pre-admission physical activity exhibited a reduced risk of the primary outcome compared with sedentary individuals [light hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.55-0.91 and vigorous HR 0.14, 95% CI 0.07-0.91, respectively]. These trends were also observed for death, cardiovascular death, or MI. When comparing physiology-guided complete revascularization vs. culprit-only strategy, no significant interaction was observed for primary and secondary endpoints when stratified by sedentary or active status. CONCLUSION: In older patients with MI, pre-admission physical activity emerges as a robust and independent prognostic determinant. Physiology-guided complete revascularization stands out an effective strategy in reducing ischaemic adverse events, irrespective of pre-admission physical activity status. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03772743.

Accesso banca dati bibliografica

PMID : 38452238

DOI : 10.1093/eurjpc/zwae069

Keywords

Humans; Male; Female; Aged; Myocardial Infarction/physiopathology/mortality; Exercise; Aged, 80 and over; Treatment Outcome; Time Factors; Sedentary Behavior; Risk Factors; Myocardial Revascularization/methods; Age Factors; Patient Admission; Risk Assessment; Coronary artery disease; Elderly; Exercise; Myocardial infarction; Myocardial revascularization;