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Prognostic impact of sarcopenia on major adverse cardiovascular outcomes in coronary artery disease patients undergoing successful percutaneous coronary intervention

Session Assessment of residual risk after percutaneous coronary intervention

Speaker Dong Oh Kang

Congress : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease and Comorbidities
  • Session type : Moderated Posters
  • FP Number : P1249

Authors : DO Kang (Seoul,KR), SY Park (Seoul,KR), Y Park (Seoul,KR), WY Jang (Seoul,KR), W Kim (Seoul,KR), BG Choi (Seoul,KR), JO Na (Seoul,KR), CU Choi (Seoul,KR), EJ Kim (Seoul,KR), S-W Rha (Seoul,KR), CG Park (Seoul,KR), S-J Hong (Seoul,KR), HS Seo (Seoul,KR)

Authors:
DO Kang1 , SY Park2 , Y Park1 , WY Jang1 , W Kim1 , BG Choi1 , JO Na1 , CU Choi1 , EJ Kim1 , S-W Rha1 , CG Park1 , S-J Hong2 , HS Seo1 , 1Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine - Seoul - Korea (Republic of) , 2Korea University Guro Hospital, Department of Radiology - Seoul - Korea (Republic of) ,

Citation:

Background: Sarcopenia is an emerging marker of frailty. Its prognostic impact on atherosclerotic cardiovascular disease (ASCVD) requires further investigation.

Purpose: We investigated the long-term prognostic impact of computed tomography (CT)-determined sarcopenia in patients with coronary artery disease (CAD).

Methods: Total 475 CAD patients those who underwent successful percutaneous coronary intervention (PCI) and performed CT scan within 30 days of PCI were enrolled. The cross-sectional area of skeletal muscle at the first lumbar vertebra (L1) level was measured. Sarcopenia was defined as L1 skeletal muscle index of less than 34.60 cm²/m² for men and of less than 25.90 cm²/m² for women. Primary outcome was 3-year all-cause mortality and secondary outcome was 3-year major adverse cardiovascular event (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization.

Results: Sarcopenia was present in 214 (45.1%) of 475 patients. The incidence of 3-year all-cause mortality and MACE was significantly higher in patients with sarcopenia than in those without sarcopenia (17.7% vs. 5.7%, p<0.001; and 35.0% vs. 11.2%, p<0.001, respectively). In the fully adjusted multivariable analysis, sarcopenia was an independent predictor of higher risk of 3-year all-cause mortality (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.35 to 6.58, p=0.007) and MACE (OR: 4.39; 95% CI: 2.49 to 7.73, p<0.001). The results were consistent after propensity-score matched analysis with 100 pairs of study population (C-statistics = 0.868).

Conclusion: Sarcopenia is a useful predictor of adverse clinical outcomes in patients with CAD undergoing PCI. CT-determined sarcopenia may further aid in risk stratification and decision-making for patients with established ASCVD.

Overall population

PSM population

Sarcopenia (n = 214) No sarcopenia (n = 261) Log-rank p-value Sarcopenia (n = 100) No sarcopenia (n = 100) Log-rank p-value
All-cause mortality 36 (17.7) 14 (5.7) <0.001 19 (20.0) 7 (7.7) 0.013
Non-fatal MI 12 (6.6) 5 (2.0) 0.021 6 (7.0) 2 (2.3) 0.134
Repeat revascularization 32 (20.3) 14 (6.2) <0.001 17 (23.3) 8 (8.0) 0.027
Total MACEs 68 (35.0) 27 (11.2) <0.001 36 (39.3) 14 (15.4) 0.001
Data are expressed as n (%). MACE = major adverse cardiovascular event; MI = myocardial infarction; PSM = propensity-score matched

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