Prognostic Review and Time-to-event Data Meta-analysis of Low Skeletal Muscle Mass in Patients with Peripheral Arterial Disease of the Lower Limbs Undergoing Revascularization

Abstract

Introduction: The relationship between low skeletal muscle mass, a surrogate of sarcopenia, and post-operative morbidity and mortality is currently being explored, with a hope to develop its role as a prognostic factor in pre-operative risk stratification. Recent evidence suggests links between low skeletal muscle mass and outcomes of lower limb revascularization in peripheral arterial disease (PAD). Methods: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prognostic factor of interest was degenerative loss of core skeletal muscle. We performed a meta-analysis for peri-interventional mortality using the odds ratio (OR) and associated 95% confidence interval (CI). For late outcomes, we conducted a time-to-event data meta-analysis using the inverse-variance method and reported the result as summary hazard ratio (HR) and associated 95% CI. We applied random-effects models of meta-analysis. Results: Six observational cohort studies reporting a total of 1235 patients (440 with low skeletal muscle mass) were eligible for quantitative synthesis. In our primary outcome of peri-interventional mortality, there was no significant difference in outcome data between patients with low skeletal muscle mass and those without (OR 1.84, 95% CI 0.40-8.43, p = 0.43). Meta-analysis of four studies found no significant difference in overall survival between patients with and without low skeletal muscle mass (HR 1.77, 95% CI 0.58-5.39, p=0.32). Patients without low skeletal muscle mass were found to have a significantly longer amputation-free survival (HR 2.75 95% CI 1.82-4.15, p< 0.00001), and a trend towards higher rates of limb salvage (HR 2.42, 95% CI 0.87 - 6.80, p=0.09) than those with low skeletal muscle mass. Conclusion: Low muscle mass is closely associated with worse disease progression following revascularization demonstrated through lower amputation free survival and limb salvage. More research is needed to further evaluate its prognostic value in revascularization of PAD patients. Disclosure: Nothing to disclose