title: High level of physical activity preserves the cardioprotective effect of preinfarction angina in elderly patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Cattedra di Geriatria, Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università degli Studi di Napoli "Federico II,", Naples, Italy. p.abete@unina.it
authors.forename: P
authors.initials: P
authors.lastname: Abete
authors.forename: N
authors.initials: N
authors.lastname: Ferrara
authors.forename: F
authors.initials: F
authors.lastname: Cacciatore
authors.forename: E
authors.initials: E
authors.lastname: Sagnelli
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.forename: V
authors.initials: V
authors.lastname: Carnovale
authors.forename: C
authors.initials: C
authors.lastname: Calabrese
authors.forename: D
authors.initials: D
authors.lastname: de Santis
authors.forename: G
authors.initials: G
authors.lastname: Testa
authors.forename: G
authors.initials: G
authors.lastname: Longobardi
authors.forename: C
authors.initials: C
authors.lastname: Napoli
authors.forename: F
authors.initials: F
authors.lastname: Rengo
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000534:rehabilitation* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000209:etiology; D003097:Collateral Circulation; D003326:Coronary Circulation; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome