Abstract
The impact of sarcopenia on atherosclerotic cardiovascular disease remains unclear. We aimed to investigate the prognostic impact of sarcopenia on coronary artery disease (CAD). A total of 475 patients with CAD who underwent successful percutaneous coronary intervention (PCI) and computed tomography (CT) were enrolled. The cross-sectional area of skeletal muscle at the first lumbar (L1) vertebral level was measured, and sex-specific cut-off values of L1 skeletal muscle index (L1 SMI; male <31.00 cm2/m2, female <25.00 cm2/m2) were obtained. The primary outcome was 3-year all-cause mortality and the secondary outcome was 3-year major adverse cardiovascular events (MACEs). Low L1 SMI was present in 141 (29.7%) of 475 patients. The incidence of all-cause mortality (23.7% vs. 5.9%, p < 0.001) and MACEs (39.6% vs. 11.8%, p < 0.001) was significantly higher in patients with low L1 SMI than in those with high L1 SMI. In multivariate analysis, low L1 SMI was an independent predictor of higher risk of all-cause mortality (hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.95–8.45; p < 0.001) and MACEs (HR: 3.76; 95% CI: 2.27–6.23; p < 0.001). These findings remained consistent after propensity score-matched analysis with 91 patient pairs (C-statistic = 0.848). CT-diagnosed low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with CAD undergoing PCI.
Highlights
Sarcopenia is characterized by age-related generalized loss of skeletal muscle mass (SMM) and muscle strength, and frequently accompanies metabolic, physical, and functional disabilities [1,2,3,4]
The areas under the curves (AUCs) for 3-year all-cause mortality in male and female subjects were 0.771 (95% confidence interval (CI): 0.685 to 0.857; p < 0.001; Figure S2-B) and 0.643, respectively
The L1 skeletal muscle index (L1 SMI) showed a weak correlation with body mass index (BMI) (Figure S3)
Summary
Sarcopenia is characterized by age-related generalized loss of skeletal muscle mass (SMM) and muscle strength, and frequently accompanies metabolic, physical, and functional disabilities [1,2,3,4]. Previous studies have reported sarcopenia as a potential predictor of the prevalence and prognosis of atherosclerotic cardiovascular disease (ASCVD) [6,7,8,9,10,11,12,13,14,15,16,17] Most of those previous studies have used traditional anthropologic measurements [6], bioelectrical impedance analysis (BIA) [6,7,8], or dual X-ray absorptiometry (DEXA) [9,10] to measure SMM. No studies have used CT to determine the presence and long-term prognostic impact of low SMM in patients with coronary artery disease (CAD) who underwent successful coronary stenting
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