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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

Physical Activity Status and Acute Coronary Syndromes Survival

The GREECS (Greek Study of Acute Coronary Syndromes) Study

Christos Pitsavos, MD, PhD^_*, Stavros A. Kavouras, PhD, Demosthenes B. Panagiotakos, PhD^,_*, Sophia Arapi, MD^_*, Costas A. Anastasiou, MS, Spyros Zombolos, MD^_*, Petros Stravopodis, MD^_*, Yannis Mantas, MD^_*, Yannis Kogias, MD^_*, Antonis Antonoulas, MD^_*, Christodoulos Stefanadis, MD, PhD^_* for the GREECS Study Investigators

^_* First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
Department of Dietetics-Nutrition, Harokopio University, Athens, Greece.

Manuscript received November 9, 2007; revised manuscript received January 23, 2008, accepted January 27, 2008.

^_* Reprint requests and correspondence: Dr. Demosthenes B. Panagiotakos, 46 Paleon Polemiston Street, 16674, Glyfada, Greece. (Email: d.b.panagiotakos{at}usa.net).

Objectives: We sought to evaluate the association between physical activity levels and the clinical outcome at presentation, as well as the 30-day prognosis of hospitalized patients with acute coronary syndromes (ACS).

Background: Regular physical activity has been associated with decreased risk of coronary heart disease. However, less is known about the effects of life-long physical activity on ACS prognosis.

Methods: From October 2003 to September 2004, a sample of 6 hospitals located in urban and rural Greek regions were selected, and almost all of their ACS patients were enrolled into the study (2,172 patients were included in the study; 76% men and 24% women). Logistic regression models were applied to evaluate the effect of physical activity status (as assessed using the International Physical Activity Questionnaire) on in-hospital mortality and the 30-day outcome of cardiovascular events (death or rehospitalization due to cardiovascular disease).

Results: An inverse association was observed between the level of physical activity and troponin I levels at presentation (p = 0.01). Moreover, after taking into account various potential confounders, physical activity was associated with a 0.56-fold (95% confidence interval [CI] 0.32 to 0.90) lower odds of in-hospital mortality and a 0.80-fold (95% CI 0.50 to 0.99) lower odds of cardiovascular events within the first month after discharge.

Conclusion: In conclusion, physical activity is associated with a reduced severity of ACS, reduced in-hospital mortality rates, and improved short-term prognosis.

Abbreviations and Acronyms   ACS = acute coronary syndromes   BMI = body mass index   CHD = coronary heart disease   CI = confidence interval   CK-MB = MB fraction of total creatine phosphokinase   CVD = cardiovascular disease   HEPA = health-enhancing physical activity   IPAQ = International Physical Activity Questionnaire   MI = myocardial infarction   UA = unstable angina