Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction

Q: What are the key findings of this study?

Gait speed independently predicted cardiovascular events after STEMI (HR 0.71 per 0.1 m/s increase; 95% CI 0.63-0.81; P<0.001), with rates of 36.7% in the slowest vs 3.2% in the fastest tertile.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (n=472). Intervention: Gait speed (measured on a 200-m course before discharge) vs. Faster vs. slower gait speed tertiles (or per 0.1 m/s increase). Primary outcome: Cardiovascular events (composite of cardiovascular deaths, nonfatal myocardial infarctions, and nonfatal ischemic strokes) (HR 0.71 per 0.1 m/s increase, 95% CI 0.63-0.81, p=<0.001).

Q: What does this research mean for the field?

Slower gait speed before hospital discharge is independently associated with an increased risk of cardiovascular events and significantly improves risk stratification beyond traditional clinical risk factors in patients with ST-segment elevation myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether measuring gait speed provides incremental prognostic value beyond the Framingham risk score, cardiac function, and comorbidities in predicting cardiovascular events after ST-segment elevation myocardial infarction.

Yasushi Matsuzawa; Masaaki Konishi; Eiichi Akiyama; Hiroyuki Suzuki; Naoki Nakayama; Masayoshi Kiyokuni; Shinichi Sumita; Toshiaki Ebina; Masami Kosuge; Kiyoshi Hibi; Kengo Tsukahara; Noriaki Iwahashi; Mitsuaki Endo; Nobuhiko Maejima; Kenichiro Saka; Katsutaka Hashiba; Kozo Okada; Masataka Taguri; Satoshi Morita; Seigo Sugiyama; Hisao Ogawa; Hironobu Sashika; Satoshi Umemura; Kazuo Kimura

doi:10.1016/j.jacc.2013.02.020

Key result

Faster gait speed linked to ~29% lower post-STEMI cardiovascular risk per 0.1 m/s increase.

HR 0.71 per 0.1 m/s increase
95% CI 0.63-0.81
P<0.001
n=472

Why the study?

Although gait speed is inversely associated with mortality in the elderly, its additional clinical value beyond the Framingham risk score, cardiac function, and comorbid conditions for predicting cardiovascular events in patients with ST-segment elevation myocardial infarction needed to be determined.

Does adding gait speed measurement before discharge improve the prediction of cardiovascular events in patients with ST-segment elevation myocardial infarction?

Key Points

To determine whether measuring gait speed provides incremental prognostic value beyond the Framingham risk score, cardiac function, and comorbidities in predicting cardiovascular events after ST-segment elevation myocardial infarction.
Evaluation of 472 patients with ST-segment elevation myocardial infarction in Japan enrolled between 2001 and 2008 (NCT01484158).
Gait speed was assessed along a 200-m course before hospital discharge, with follow-up tracking cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke over 2,596 person-years.
Cardiovascular events occurred in 83 patients (17.6%), increasing stepwise across decreasing gait speed tertiles: 3.2% (n=5) in the fastest, 12.6% (n=20) in the middle, and 36.7% (n=58) in the slowest tertile.
Multivariable Cox proportional hazards analysis showed each 0.1 m/s increase in gait speed was independently associated with fewer cardiovascular events (HR 0.71, 95% CI 0.63 to 0.81, p < 0.001).
Adding gait speed to a model containing Framingham risk score, B-type natriuretic peptide, and comorbidity index significantly improved risk reclassification (net reclassification index 32.8%, 95% CI 17.4 to 48.3, p < 0.001) and discrimination (C-statistic increased from 0.703 [95% CI 0.636 to 0.763] to 0.786 [95% CI 0.738 to 0.829]).

Study Design

Type

Observational (n=472)

Multicenter

No

Structured PICO

Does adding gait speed measurement before discharge improve the prediction of cardiovascular events in patients with ST-segment elevation myocardial infarction?

P

Population

472 patients with ST-segment elevation myocardial infarction in Japan between 2001 and 2008, followed for 2,596 person-years.

E

Exposure

Gait speed measurement using a 200-m course before discharge (evaluated across tertiles of gait speed and per 0.1 m/s increase)

C

Comparator

Risk prediction model incorporating Framingham risk score (FRS), B-type natriuretic peptide levels, and comorbidity index without gait speed (or comparison across fastest, middle, and slowest tertiles of gait speed)

O

Outcome

Composite of cardiovascular events consisting of cardiovascular deaths, nonfatal myocardial infarctions, and nonfatal ischemic strokes over 2,596 person-years of follow-upcomposite

Main Result

Hazard Ratio: 0.71 (95% CI 0.63–0.81)

Absolute Event Rate: 36.7% vs 3.2%

p-value: p=<0.001

Slow gait speed measured before hospital discharge is independently associated with a higher risk of subsequent cardiovascular events and improves risk reclassification in STEMI patients.

Limitations

single-center prospective observational study

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Implication

Gait speed may refine post-STEMI risk stratification beyond Framingham and BNP models; leaves open prospective validation before clinical adoption.

Abstract

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).

Discussion

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Cite This Study

Matsuzawa et al. (2013) conducted an observational in ST-segment elevation myocardial infarction (n=472). Gait speed (measured on a 200-m course before discharge) vs. Faster vs. slower gait speed tertiles (or per 0.1 m/s increase) was evaluated on Cardiovascular events (composite of cardiovascular deaths, nonfatal myocardial infarctions, and nonfatal ischemic strokes) (HR 0.71 per 0.1 m/s increase, 95% CI 0.63-0.81, p=<0.001). Gait speed independently predicted cardiovascular events after STEMI (HR 0.71 per 0.1 m/s increase; 95% CI 0.63-0.81; P<0.001), with rates of 36.7% in the slowest vs 3.2% in the fastest tertile.

synapsesocial.com/papers/6af237fc0726013861ef3325 https://doi.org/10.1016/j.jacc.2013.02.020

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Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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