Clinical Impact of Sarcopenia Screening on Long-Term Mortality in Patients Undergoing Coronary Bypass Grafting

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-11-08 DOI:10.1002/jcsm.13645

Seung Hun Lee, Jinhwan Jo, Jeong Hoon Yang, Sung Mok Kim, Ki Hong Choi, Young Bin Song, Dong Seop Jeong, Joo Myung Lee, Taek Kyu Park, Joo-Yong Hahn, Seung-Hyuk Choi, Su Ryeun Chung, Yang Hyun Cho, Kiick Sung, Wook Sung Kim, Hyeon-Cheol Gwon, Young Tak Lee

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Abstract

Background

Sarcopenia is an aging-related condition characterized by loss of skeletal muscle mass and is an indicator of subclinical atherosclerosis. The relationship between reduced muscle mass and long-term clinical outcomes in patients with advanced coronary artery disease who have undergone coronary artery bypass grafting (CABG) is not fully understood. This study is sought to evaluate the prognostic implications of sarcopenia screening in patients undergoing CABG.

Methods

A total of 2810 patients who underwent CABG were analysed and classified according to presence of reduced muscle mass. The skeletal muscle index (SMI) was calculated as L3 muscle area (cm²)/height (m)² on computed tomography. Reduced SMI was defined as SMI ≤ 45 cm²/m² in male and ≤ 38 cm²/m² in female. The primary outcome was all-cause mortality, and survival analysis was performed using the Kaplan–Meier method and compared with the log-rank test.

Results

The median follow-up was 8.7 years, and 924 patients (32.9%) had reduced SMI. Patients with reduced SMI were older (67.7 ± 8.8 vs. 62.2 ± 9.8 years; p < 0.001) and less frequently male (69.8% vs. 81.1%; p < 0.001). SMI was significantly associated with risk of death on a restricted cubic spline curve (HR = 1.04 per-1 decrease; 95% CI 1.03–1.05; p < 0.001). Patients with reduced SMI had a higher incidence of long-term mortality than those with preserved SMI (survival rate 41.4% vs. 62.8%; HR_adj = 1.18, 95% CI 1.03–1.36, p = 0.020). Subgroup analysis showed that the prognostic implication of reduced SMI on long-term survival was more evident in male (HR_adj = 2.01, 95% CI 1.72–2.35) than female (HR_adj = 1.28, 95% CI 0.98–1.68) (interaction p = 0.006).

Conclusions

Reduced muscle mass, defined by SMI on computed tomography, was associated with long-term mortality after CABG. These results provide contemporary data to allow the evaluation of physical frailty in patients with advanced coronary artery disease before surgery.

Trial Registration: Long-Term Outcomes and Prognostic Factors in Patients Undergoing CABG or PCI: NCT03870815

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肌肉疏松症筛查对冠状动脉旁路移植术患者长期死亡率的临床影响

背景肌肉疏松症是一种与衰老有关的疾病，其特点是骨骼肌量减少，是亚临床动脉粥样硬化的一个指标。接受冠状动脉旁路移植术（CABG）的晚期冠状动脉疾病患者肌肉质量下降与长期临床预后之间的关系尚未完全明了。本研究旨在评估肌肉疏松症筛查对接受冠状动脉旁路移植术患者预后的影响。方法：本研究共分析了 2810 名接受冠状动脉旁路移植术的患者，并根据肌肉质量是否减少进行了分类。骨骼肌指数（SMI）根据计算机断层扫描的 L3 肌肉面积（平方厘米）/身高（米）2 计算得出。男性骨骼肌指数≤45 cm2/m2，女性骨骼肌指数≤38 cm2/m2，即为骨骼肌指数降低。主要结果是全因死亡率，采用 Kaplan-Meier 法进行生存分析，并用对数秩检验进行比较。结果中位随访时间为 8.7 年，924 名患者（32.9%）的 SMI 降低。SMI降低的患者年龄较大（67.7 ± 8.8 岁 vs. 62.2 ± 9.8 岁；p < 0.001），男性较少（69.8% vs. 81.1%；p < 0.001）。在限制性立方样条曲线上，SMI 与死亡风险明显相关（HR = 1.04 per-1 decrease; 95% CI 1.03-1.05; p <0.001）。与保留 SMI 的患者相比，SMI 降低的患者的长期死亡率更高（存活率为 41.4% 对 62.8%；HRadj = 1.18，95% CI 1.03-1.36，p = 0.020）。亚组分析显示，SMI降低对长期生存的预后影响在男性（HRadj = 2.01，95% CI 1.72-2.35）比女性（HRadj = 1.28，95% CI 0.98-1.68）更明显（交互作用 p = 0.006）。这些结果为晚期冠状动脉疾病患者在手术前评估体质虚弱程度提供了现代数据：接受 CABG 或 PCI 患者的长期结果和预后因素：NCT03870815

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.