Decreased Appendicular Skeletal Muscle Mass is Associated with Poor Outcomes after ST-Segment Elevation Myocardial Infarction

Abstract

The importance of sarcopenia in cardiovascular diseases has been recently demonstrated. This study aims to examine whether skeletal muscle mass (SMM), an important component of sarcopenia, is associated with an increased risk of poor outcome in patients after ST-segment elevation myocardial infarction (STEMI). Methods: We measured SMM in 387 patients with STEMI using dual-energy X-ray absorptiometry. Patients were divided into low-and high-appendicular skeletal mass index (ASMI: appendicular SMM divided by height squared (kg/m 2)) groups using the first quartile of ASMI (≤ 6.64 kg/m 2 for men and ≤ 5.06 kg/m 2 for women). All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization. Results: Low-ASMI group was older and had a more complex coronary lesion, a lower left ventricular ejection fraction, and a higher prevalence of Killip classification ≥ 2 than high-ASMI group. During a median follow-up of 33 months, the event rate was significantly higher in low-ASMI group than in high-ASMI group (24.7% vs 13.4%, log-rank p 0.001). Even after adjustment for patients' background, low ASMI was independently associated with the high risk of primary composite events (adjusted hazard ratio 2.06, 95% confidence interval 1.01-4.19, p 0.04). In the subgroup analyses of male patients (n 315), the optimal cutoff point of ASMI for predicting primary composite outcome was 6.75 kg/m 2 , which was close to its first quartile value. Conclusions: Low ASMI is independently associated with poor outcome in patients with STEMI.

Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

“…2 A and Table 1 ). Figure 2 B and Table 1 show that this association was observed in prospective cohort studies [ 41 , 43 , 44 , 52 ] (HR = 2.23, 95%CI: 1.28–3.90, P = 0.005; I 2 = 78.8%, P heterogeneity = 0.003) and retrospective cohort studies [ 39 , 40 , 42 ] (HR = 2.32, 95%CI: 1.46–3.67, P < 0.001; I 2 = 0%, P heterogeneity = 0.665). When considering the definitions of sarcopenia, the results showed that the association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia [ 39 , 40 , 52 ] (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I 2 = 0%, P heterogeneity = 0.604) (Fig.…”

“…Supplementary Table S3 shows that four studies [ 38 – 40 , 42 ] scored 8 points on the NOS, and six studies [ 35 , 41 , 43 , 44 , 52 , 53 ] scored 9 points.…”

Loss of Skeletal Muscle Mass and Poor Prognosis in Patients with ST-Segment Elevation Myocardial Infarction: Underling Mechanisms and Therapeutic Strategies

“…As mentioned by the authors, this study is the first to present important findings regarding the significant association between decreased skeletal muscle mass and poor outcomes in patients with STEMI 10) . Interestingly, a lower cutoff value may be better for predicting the primary composite events in male patients with STEMI compared with the AWGS criteria, which was developed based on studies on young Asian adults.…”

“…High Technology Research Center Grant, Strategic Research Foundation at Private Universities and KAKENHI (17K01470, 19K11374) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. mary composite events (hazard ratio, 2.06) 10) .…”

“…In this issue of the Journal of Atherosclerosis Thrombosis, Sato et al have reported novel aspects of decreased skeletal muscle mass and poor outcomes in 387 patients with ST-segment elevation myocardial infarction (STEMI) 10) . The skeletal muscle mass of the study participants was measured using dual-energy X-ray absorptiometry.…”