The New England journal of medicine · 2025
Multidomain Rehabilitation for Older Patients with Myocardial Infarction.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Tonet Elisabetta, Raisi Andrea, Zagnoni Silvia, Chiaranda Giorgio, Pasanisi Giovanni, Aschieri Daniela, D'Intino Paola Emanuela, Pavasini Rita, Cimaglia Paolo, Campana Roberta, Vitali Francesco, Piva Tommaso, Casella Gianni, Caglioni Serena, Zerbini Valentina, Bugani Giulia, Cocco Marta, Menegatti Erica, De Raffele Martina, Mandini Simona, Martella Donato, Pesenti Nicola, Mazzoni Gianni, Biscaglia Simone, Volpato Stefano, Grazzi Giovanni, Campo Gianluca, PIpELINe Trial Investigators
Аннотация
BACKGROUND: The benefit of rehabilitation interventions in patients who are 65 years of age or older with myocardial infarction and impaired physical performance remains unclear.
METHODS: In this multicenter, randomized trial conducted in Italy, we assigned older patients with impaired physical performance 1 month after myocardial infarction in a 2:1 ratio to receive either an intervention consisting of control of cardiovascular risk factors, dietary counseling, and exercise training (intervention group) or usual care (control group). The primary outcome was a composite of cardiovascular death or unplanned hospitalization for cardiovascular causes within 1 year.
RESULTS: A total of 512 patients underwent randomization (342 to the intervention group and 170 to the control group). The median age of the patients was 80 years, and 36% were women. A primary-outcome event occurred in 43 patients (12.6%) in the intervention group and in 35 patients (20.6%) in the control group (hazard ratio, 0.57; 95% confidence interval [CI], 0.36 to 0.89; P = 0.01). Cardiovascular death occurred in 14 patients (4.1%) in the intervention group and in 10 patients (5.9%) in the control group (hazard ratio, 0.69; 95% CI, 0.31 to 1.55). Unplanned hospitalization for cardiovascular causes occurred in 31 patients (9.1%) in the intervention group and in 30 patients (17.6%) in the control group (hazard ratio, 0.48; 95% CI, 0.29 to 0.79). There were no serious adverse events associated with the intervention.
CONCLUSIONS: Among older patients with impaired physical performance 1 month after myocardial infarction, a multidomain rehabilitation intervention resulted in a lower incidence of cardiovascular death or unplanned cardiovascular hospitalization within 1 year than usual care. (Funded by the Italian Health Ministry; PIpELINe ClinicalTrials.gov number, NCT04183465.).
METHODS: In this multicenter, randomized trial conducted in Italy, we assigned older patients with impaired physical performance 1 month after myocardial infarction in a 2:1 ratio to receive either an intervention consisting of control of cardiovascular risk factors, dietary counseling, and exercise training (intervention group) or usual care (control group). The primary outcome was a composite of cardiovascular death or unplanned hospitalization for cardiovascular causes within 1 year.
RESULTS: A total of 512 patients underwent randomization (342 to the intervention group and 170 to the control group). The median age of the patients was 80 years, and 36% were women. A primary-outcome event occurred in 43 patients (12.6%) in the intervention group and in 35 patients (20.6%) in the control group (hazard ratio, 0.57; 95% confidence interval [CI], 0.36 to 0.89; P = 0.01). Cardiovascular death occurred in 14 patients (4.1%) in the intervention group and in 10 patients (5.9%) in the control group (hazard ratio, 0.69; 95% CI, 0.31 to 1.55). Unplanned hospitalization for cardiovascular causes occurred in 31 patients (9.1%) in the intervention group and in 30 patients (17.6%) in the control group (hazard ratio, 0.48; 95% CI, 0.29 to 0.79). There were no serious adverse events associated with the intervention.
CONCLUSIONS: Among older patients with impaired physical performance 1 month after myocardial infarction, a multidomain rehabilitation intervention resulted in a lower incidence of cardiovascular death or unplanned cardiovascular hospitalization within 1 year than usual care. (Funded by the Italian Health Ministry; PIpELINe ClinicalTrials.gov number, NCT04183465.).