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Reduced skeletal muscle mass is associated to worsened long-term clinical outcomes in patients with coronary artery disease: a quantitative analysis by computed tomography

Session Physical activity, exercise, and sports

Speaker Dong Oh Kang

Event : ESC Congress 2019

  • Topic : preventive cardiology
  • Sub-topic : Prevention – Cardiovascular Risk Assessment: Imaging
  • Session type : Rapid Fire Abstracts

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 closely associated to poor clinical outcomes in patients with atherosclerotic cardiovascular disease (ASCVD). However, it is unclear whether the skeletal muscle mass at baseline has quantitative effect on future cardiovascular outcomes.

Purpose: We investigated the quantitative effect of skeletal muscle mass on future cardiovascular outcomes in patients with coronary artery disease (CAD).

Methods: Total 475 patients those who underwent successful percutaneous coronary intervention (PCI) for CAD and performed computed tomography (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. Whole study population was divided into 4 groups according to the sex-specific quartiles of skeletal muscle index (SMI). Primary outcome was all-cause mortality and secondary outcome was major adverse cardiovascular event (MACE) within 3 years of follow-up.

Results: Mean follow-up duration was 4.11 ± 3.02 years and average time period from the date of PCI to CT scan was -3.33 ± 11.72 days. The incidence of 3-year all-cause mortality (23.2% vs. 9.9% vs. 6.6% vs. 4.4%, p<0.001) and MACE (42.9% vs. 24.0% vs. 14.3% vs. 6.2%, p<0.001) was significantly higher in the group of lower quartiles of L1-SMI. In the fully adjusted multivariable analysis, lower quartiles of L1-SMI was an independent predictor of higher risk of all-cause mortality and MACE (lowest vs. highest quartile; OR: 4.90, 95% CI: 1.54 to 15.5, p=0.007; and OR: 12.3, 95% CI: 4.99 to 30.4, p<0.001, respectively).

Conclusion: Skeletal muscle mass at baseline is a powerful predictor of future adverse clinical outcomes in patients with CAD undergoing successful PCI. Quantitative assessment of skeletal muscle mass at L1 level by CT scan provides prognostic implication for future cardiovascular risk stratification.

SMI Q1 (n=124) SMI Q2 (n=116) SMI Q3 (n=112) SMI Q4 (n=123) Log-rank p-value
All-cause mortality 27 (23.2) 11 (9.9) 7 (6.6) 5 (4.4) <0.001
Non-fatal MI 9 (8.7) 3 (3.0) 2 (2.0) 3 (2.6) 0.038
Repeat revascularization 20 (24.9) 15 (15.2) 7 (7.1) 4 (3.8) <0.001
Total MACEs 47 (42.9) 26 (24.0) 15 (14.3) 7 (6.2) <0.001
Data are expressed as n (%). MACE = major adverse cardiovascular event; MI = myocardial infarction; SMI = skeletal muscle index; Q = quartile

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