Physical performance and outcomes after myocardial infarction in older patients undergoing multidomain cardiac rehabilitation

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ID: 328915
2026
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Abstract
Abstract Aims To investigate the prognostic role of physical performance as a marker of vulnerability in older patients after myocardial infarction and its interaction with a multidomain cardiac rehabilitation intervention. Methods and results In this prespecified subanalysis of the PIpELINe trial, physical performance was evaluated using the Short Physical Performance Battery (SPPB). Patients aged ≥65 years with intermediate SPPB scores (4–9) were randomized in a 2:1 ratio to a multidomain rehabilitation programme or usual care. The primary outcome was a composite of cardiovascular death or unplanned hospitalization for cardiovascular causes at 1 year. Associations between baseline SPPB, its individual components, longitudinal changes over time, and clinical outcomes were examined using competing-risk models. Among 512 randomized patients, lower baseline SPPB scores were associated with a significantly higher risk of the primary outcome (HR 0.51, 95% CI 0.32–0.82). No interaction was observed between baseline SPPB and treatment assignment, indicating a consistent benefit of intervention across levels of physical performance. Among individual SPPB components, gait speed emerged as the strongest prognostic marker, with an approximately 50% reduction in risk per 1-point increase (HR 0.50, 95% CI 0.37–0.68; P < 0.001). Improvement in SPPB of at least one point during follow-up was associated with a lower risk of adverse outcomes. Conclusion In older myocardial infarction patients, baseline physical performance is a strong and independent predictor of adverse cardiovascular outcomes without modifying the benefit of multidomain cardiac rehabilitation. Gait speed represents a simple and pragmatic marker of risk, and functional improvement over time is associated with better prognosis. Registration ClinicalTrials.gov NCT03021044
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Authors Andrea Raisi, Valentina Zerbini, Elisabetta Tonet, Silvia Zagnoni, Giorgio Chiaranda, Daniela Aschieri, Giovanni Pasanisi, Paola E. D'Intino, Rita Pavasini, Paolo Cimaglia, Gianni Casella, Serena Caglioni, Marta Helena Cocco, Simone Biscaglia, Gianluca Campo, Stefano Volpato, Nicola Grazzi, Tommaso Piva, Erica Menegatti, Gianni Mazzoni, Giovanni Grazzi, Simona Mandini
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Journal european journal of preventive cardiology
Year 2026
DOI
10.1093/eurjpc/zwag390
URL
https://doi.org/10.1093/eurjpc/zwag390
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