Abstract P129: Impact of Regular Physical Activity on Prognosis After Myocardial Infarction: The OACIS Study
Introduction: It has been demonstrated that regular physical activities improve physical capacities and prognosis in survivor patients with acute myocardial infarction (AMI), especially in well-designed, relatively small patients cohorts. However, impacts of regular physical activity on prognosis are not fully elucidated in large scale, real-world settings because of varieties of confounding factors.
Hypothesis: We assessed the hypothesis that regular physical activity at 3-month after AMI is an independent predictor for 5-year survival in a large cohort of post-MI patients registered in the Osaka Acute Coronary Insufficiency Study (OACIS).
Methods: The OACIS is a prospective, multicenter, observational study enrolling consecutive patients with AMI at 25 collaborating hospitals in the Osaka region of Japan. Among 8957 patients registered in the OACIS, 5218 patients who reported physical activities at 3-month after MI were enrolled and were followed for 5 years. Multivariate Cox regression was used with the following variables as covariates: age, gender, BMI, HT, DM, dyslipidemia, smoking, ST-elevation MI, NYHA at 3-month after MI, reperfusion therapy, multivessel disease, depression status by SDS score, living alone, and beta-blocker, statin, antiplatelet agent, ACEI/ARB, calcium channel blocker, and diuretics therapy.
Results: Regular physical activity at 3-month after MI were seen 1180 patients (22.8%, total n=5170). Cumulative mortality at 5-year after MI was 3.5%, which was lower than that in the patients without regular physical activity (3990 patients, 7.9% log-rank p<0.001). However. the difference was not statistically significant in the multivariate analysis (adjusted HR 0.66, 95%CI 0.38-1.07, p=0.088). Cumulative mortality at 5-year after MI was 10.9%, which was highest (log-rank p<0.001, total n=5218) in lowest quartile of maximum physical capacity (Q1: medium 4.5 Mets, n=1911) compared to 4.7% in the Q2 (median 5.5 Mets, n=681), 3.1% in the Q3 (median 6.5 Mets, n=1261), and 2.7% in the Q4 (median 7.5 Mets, n=1365). Cumulative mortality at 5-year after MI was highest (9.9%) in the patients’ activity changed from active to inactive after MI and was lowest (3.1%) in those changed from inactive to active (log-rank p<0.001, total n=5204). Factors which related to start regular exercise after MI are male (OR 1.91), statin (1.59), and beta-blocker (1.33), whereas to give up was NYHA>2 (OR 0.36, 95%CI 0.23-0.55, p=0.001). Frequency of cardiac death was higher in the patients without regular physical activity than with regular physical activity.
Conclusion: Regular physical activity apparently related to better prognosis after AMI, but was not an independent predictor for 5-year mortality.
Author Disclosures: M. Usami: None. Y. Sakata: None. D. Nakatani: None. H. Mizuno: None. S. Suna: None. S. Matsumoto: None. M. Shimizu: None. H. Sato: None.
- © 2016 by American Heart Association, Inc.