Impact of pre-admission physical activity on benefits of physiology-guided complete revascularization in older patients with myocardial infarction: insights from the FIRE trial.

Fecha de publicación: 07/03/2024 Fecha Ahead of Print: 07/03/2024

Autores de IIS La Fe

Ramon Moreno Balsalobre

Autor
José Luis Díez Gil

Autor

Participantes ajenos a IIS La Fe

Pavasini R
Campo G
Serenelli M
Tonet E
Guiducci V
Escaned J
Casella G
Cavazza C
Varbella F
Sacchetta G
Arena M
Santos IA
Ibañes EG
Scarsini R
D'Amico G
Ruiz-Poveda FL
Pignatelli G
Iannopollo G
Colaiori I
Santos RC
Marrone A
Fileti L
Rigattieri S
Barbato E
Ocaranza-Sanchez R
Biscaglia S

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

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.

Datos de la publicación

ISSN/ISSNe:: 2047-4873, 2047-4881
Tipo:: Article
Páginas:: 1451-1459
DOI:: 10.1093/eurjpc/zwae069
PubMed:: 38452238
Factor de Impacto:: 1,689 SCImago ℠
Cuartil:: Q1 SCImago ℠

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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
Tonet E:: Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy
Guiducci V:: Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria Nuova Hospital, Viale Risorgimento 80, Reggio Emilia 42123, Italy
Escaned J:: Cardiovascular Department, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martin Lagos s/n, Madrid 28040, Spain
Moreno R:: Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 261, 28046, Madrid, Spain
Casella G:: Cardiology Unit, Ospedale Maggiore, Largo Nigrisoli 2, Bologna 40133, Italy
Cavazza C:: Cardiovascular Department, Infermi Hospital, Viale Luigi Settembrini 2, Rimini 47923, Italy
Varbella F:: Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASLTO3, Rivoli (TO) 10098, Italy
Sacchetta G:: Cardiology Unit, Umberto I Hospital, ASP Siracusa, Via Giuseppe Testaferrata, 1, 96100 Siracusa, Italy
Arena M:: S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia 19124, Italy
Santos IA:: Department of Cardiology, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
Ibañes EG:: Department of Cardiology, Centro de Investigation Biomedica end Red en Enfermedades Cardiovasculares, H. Universitario y Politécnico La Fe, Valencia 46026, Spain
Scarsini R:: Cardiovascular Department, Azienda Ospedaliero Universitaria Integrata di Verona, Piazzale Aristide Stefani, 1 - 37126 Verona, Italy
D'Amico G:: Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Via Paccagnella, 12, 35128 Mestre (Venice), Italy
Ruiz-Poveda FL:: Cardiovascular Department, Hospital General Universitario de Ciudad Real, 13001, Ciudad Real, Spain
Díez Gil JL:: Cardiology Unit, Hospital San Giovanni di Dio, Azienda Sanitaria Provinciale Agrigento, Agrigento 92100, Italy
Pignatelli G:: Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria Nuova Hospital, Viale Risorgimento 80, Reggio Emilia 42123, Italy
Iannopollo G:: Cardiology Unit, Ospedale Maggiore, Largo Nigrisoli 2, Bologna 40133, Italy
Colaiori I:: Cardiology Unit, Ospedale Santa Maria Goretti, Via Lucia Scaravelli, Latina 04100, Italy
Santos RC:: Department of Interventional Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias, 84, 15006 A Coruña, Spain
Marrone A:: Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy
Fileti L:: Cardiology Department, S. Maria delle Croci Hospital, Viale Randi 5, Ravenna 48121, Italy
Rigattieri S:: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1035/1039 00189 Roma, Italy
Barbato E:: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1035/1039 00189 Roma, Italy
Ocaranza-Sanchez R:: Servicio de Cardiología, Hospital Universitario Lucus Augusti, 27001 Lugo, Spain
Biscaglia S:: Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy