Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction
Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction
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DOI：
10.1016/j.jacc.2013.02.020
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发表时间：
2013-05-14
影响因子：
24
通讯作者：
Kimura, Kazuo
中科院分区：
文献类型：
--
作者：
Matsuzawa, Yasushi;Konishi, Masaaki;Kimura, Kazuo
目的本研究旨在确定步态速度对弗雷明汉风险评分（FRS）、心脏功能和合并症在预测ST段抬高心肌梗死患者心血管事件方面的额外临床价值。背景越来越多的证据表明步态速度与全因死亡率呈负相关，特别是心血管死亡率，方法：我们在2001年至2008年期间对472例日本ST段抬高型心肌梗死患者的步态速度进行了单中心前瞻性观察研究。步态速度进行了测量，使用200米的课程在所有患者出院前，我们随访了心血管事件，其中包括心血管死亡，非致命性心肌梗死，非致命性缺血性stroks.Results在2,596人年的随访，83例（17.6%）经历了心血管事件。随着步态速度的降低，心血管事件增加（最快三分位数：n = 5，3.2%;中间三分位数：n = 20，12.6%;最慢三分位数，n = 58，36.7%）。通过多重校正的考克斯比例风险分析，步态速度是心血管事件的显著和独立的预测因子（步态速度增加0.1 m/s的风险比：0.71，95%置信区间[CI]：0.63至0.81，p < 0.001）。在模型中增加步态速度，结合FRS，B型利钠肽水平和合并症指数，改善了重新分类（净重新分类指数：32.8%，95% CI：17.4至48.3，p < 0.001）和具有合理整体拟合和校准的C统计量结论在ST段抬高型心肌梗死患者中，缓慢的步行速度与心血管事件的风险增加显著相关。(Gait预测心肌梗死后心血管事件的速度; NCT 01484158）（C）2013，美国心脏病学会基金会
Objectives This study sought to determine the additional clinical value of gait speed to Framingham risk score (FRS), cardiac function, and comorbid conditions in predicting cardiovascular events in patients with ST-segment elevation myocardial infarction.Background There is growing evidence that gait speed is inversely associated with all-cause mortality, particularly cardiovascular mortality, among the elderly.Methods We undertook a single-center prospective observational study of gait speed in 472 patients with ST-segment elevation myocardial infarction in Japan, between 2001 and 2008. Gait speeds were measured using a 200-m course before discharge in all patients, and we followed up cardiovascular events, which consist of cardiovascular deaths, nonfatal myocardial infarctions, and nonfatal ischemic strokes.Results During the 2,596 person-years of follow-up, 83 patients (17.6%) experienced cardiovascular events. Cardiovascular events increased across decreasing tertiles of gait speed (fastest tertile: n = 5, 3.2%; middle tertile: n = 20, 12.6%; slowest tertile, n = 58, 36.7%). By multiple adjusted Cox proportional hazards analysis, gait speed was a significant and independent predictor of cardiovascular events (hazard ratio for increasing 0.1 m/s of gait speed: 0.71, 95% confidence interval [CI]: 0.63 to 0.81, p < 0.001). The addition of gait speed to the model incorporating FRS, B-type natriuretic peptide levels, and comorbidity index improved reclassification (net reclassification index: 32.8%, 95% CI: 17.4 to 48.3, p < 0.001) and the C-statistics with a reasonable global fit and calibration (C-statistics: from 0.703 [95% CI: 0.636 to 0.763] to 0.786 [95% CI: 0.738 to 0.829]).Conclusions Among patients with ST-segment elevation myocardial infarction, slow gait speed was significantly associated with an increased risk of cardiovascular events. (Gait Speed for Predicting Cardiovascular Events After Myocardial Infarction; NCT01484158) (C) 2013 by the American College of Cardiology Foundation