Age, sex and habitual physical activity as determinants of multi-vessel coronary disease in acute myocardial infarction
C Cinezan, C B RusAbstract
Background
The angiographic extent of coronary artery disease (CAD) strongly influences prognosis in patients with acute myocardial infarction (MI). While age, sex, and traditional cardiovascular risk factors are known determinants of atherosclerosis, the independent relationship between habitual physical activity and anatomical CAD burden at the time of MI remains insufficiently defined.
Objectives
To evaluate age- and sex-related differences in CAD extent and to determine whether preadmission physical activity independently predicts multi-vessel disease beyond traditional cardiometabolic risk factors.
Methods
We prospectively included 306 consecutive patients with STEMI or NSTEMI who underwent coronary angiography. CAD was classified as single-vessel or multi-vessel disease (≥2 significantly stenosed vessels). Habitual physical activity during the four weeks preceding admission was assessed using a self-reported 10-point effort scale. Hierarchical multivariable logistic regression models were constructed: (1) age and sex; (2) addition of physical activity; (3) addition of traditional risk factors (smoking, hypertension, diabetes, hyperlipidemia, BMI); and (4) fully adjusted model. Model discrimination was assessed using area under the ROC curve (AUC).
Results
Multi-vessel CAD was present in 60.5% of patients. Age was independently associated with multi-vessel disease across all models. Sex was not independently associated after adjustment. In the fully adjusted model, lower physical activity remained a strong independent predictor of multi-vessel CAD (OR 0.567 per 1-point increase; 95% CI 0.494–0.651; p<0.001). Diabetes, hypertension, and hyperlipidemia were also independently associated with disease extent. Inclusion of physical activity significantly improved model discrimination (AUC 0.701 vs. 0.861; p<0.001).
Conclusions
Lower habitual physical activity is independently associated with more extensive angiographic CAD in patients with MI, providing incremental predictive value beyond traditional risk factors. These findings support systematic assessment of physical activity in risk stratification and reinforce its central role in cardiovascular prevention strategies.Figure 2