Physical Performance After Acute Myocardial Infarction: Gait, Frailty, and Cardiovascular Prognosis

Abstract Purpose of Review Physical performance and frailty have emerged as potential markers of physiological reserve and cardiovascular vulnerability after acute myocardial infarction (AMI). This review examines the prognostic significance of gait speed, lower-extremity physical performance, frailty, and sarcopenia after AMI and acute coronary syndrome (ACS) and discusses their underlying pathophysiological mechanisms and clinical implications. Recent Findings Slow gait speed, impaired Short Physical Performance Battery (SPPB) scores, and frailty are associated with mortality, rehospitalization, heart failure, and adverse cardiovascular events after AMI or ACS. Gait speed and SPPB may provide incremental prognostic information beyond conventional cardiovascular risk assessment and established risk scores. These associations may reflect an interconnected cardiac–vascular–muscle axis involving reduced cardiac reserve, vascular dysfunction, impaired skeletal muscle perfusion, sarcopenia, and physical deconditioning. Importantly, emerging evidence suggests that targeted cardiac rehabilitation may improve gait speed, muscle strength, and overall physical performance in vulnerable patients. Summary Physical performance represents a clinically relevant and potentially modifiable dimension of post-AMI cardiovascular vulnerability. Incorporating gait speed, SPPB, and frailty assessment into conventional risk stratification may improve patient phenotyping and identify individuals requiring more intensive rehabilitation and follow-up. Further prospective studies are needed to standardize assessment strategies and determine whether improving physical performance translates into better cardiovascular outcomes.