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MYOCARDIAL INFARCTION

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

Pasquale Abete, MD, PhD^*,*, Nicola Ferrara, MD , Francesco Cacciatore, MD, PhD^{* ||}, Elio Sagnelli, MD^*, Maria Manzi, MD^*, Vincenzo Carnovale, MD^*, Claudio Calabrese, MD^{* ||}, Domenico de Santis, MD^*, Gianluca Testa, MD^*, Giancarlo Longobardi, MD, Claudio Napoli, MD, PhD, FACA ^¶ and Franco Rengo, MD^*

^* Cattedra di Geriatria, Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università degli Studi di Napoli "Federico II," Naples, Italy
Cattedra di Medicina Interna, Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università degli Studi di Napoli "Federico II," Naples, Italy
Cattedra di Geriatria, Dipartimento delle Malattie del Metabolismo e dell’Invecchiamento, Seconda Università di Napoli, Naples, Italy
Centro Medico di Telese Terme, Fondazione Salvatore Maugeri, IRCCS, Benevento, Italy
^|| U.O. Riabilitazione, A.S.L. 4 Basso Molise, Fondazione Salvatore Maugeri, Larino/Termoli, Italy
^¶ Department of Medicine-0682, University of California, San Diego, California, USA

Manuscript received December 12, 2000; revised manuscript received April 19, 2001, accepted July 19, 2001.

^* Reprint requests and correspondence: Dr. Pasquale Abete, Dipartimento di Medicina Clinica e Scienze Cardiovascolari, Cattedra di Geriatria, Università degli Studi di Napoli "Federico II," Via S. Pansini, 5, 80131 Napoli, Italy.
p.abete{at}unina.it

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.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CCU = coronary care unit   CHD = coronary heart disease   CI = confidence interval   CK = creatine kinase   CK-MB = creatine kinase-myoglobin fraction   ECG = electrocardiographic   OR = odds ratio   PASE = Physical Activity Scale for the Elderly   PC = ischemic preconditioning   PTCA = percutaneous transluminal coronary angioplasty

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