BackgroundSarcopenia 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.MethodsA 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.ResultsThe 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%; HRadj = 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 (HRadj = 2.01, 95% CI 1.72–2.35) than female (HRadj = 1.28, 95% CI 0.98–1.68) (interaction p = 0.006).ConclusionsReduced 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

中文翻译：

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肌肉减少症筛查对冠状动脉旁路移植术患者远期死亡率的临床影响


背景肌肉减少症是一种与衰老相关的疾病，其特征是骨骼肌质量的丧失，是亚临床动脉粥样硬化的指标。尚不完全清楚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减少与长期临床结果之间的关系。本研究旨在评估肌肉减少症筛查对接受 CABG 的患者的预后影响。方法对 2810 例接受 CABG 的患者进行分析和分类，根据肌肉质量减少的情况进行分类。骨骼肌指数 （SMI） 在计算机断层扫描上计算为 L3 肌肉面积 （cm2）/身高 （m）2。降低的 SMI 定义为男性 SMI ≤ 45 cm2/m2，女性 ≤ 38 cm2/m2。主要结局是全因死亡率，使用 Kaplan-Meier 方法进行生存分析，并与对数秩检验进行比较。结果中位随访 8.7 年，924 例患者 （32.9%） SMI 降低。SMI 降低的患者年龄较大 （67.7 ± 8.8 vs. 62.2 ± 9.8 岁;p < 0.001） 和较少见于男性 （69.8% vs. 81.1%;p < 0.001）。SMI 与限制性三次样条曲线上的死亡风险显著相关 （HR = 1.04/1 下降;95% CI 1.03–1.05;p < 0.001）。SMI 降低的患者长期死亡率高于保留 SMI 的患者（生存率 41.4% 对 62.8%;HRadj = 1.18,95% CI 1.03–1.36，p = 0.020）。亚组分析显示，SMI 降低对长期生存率的预后影响在男性 （HRadj = 2.01， 95% CI 1.72-2.35） 中比女性 （HRadj = 1.28， 95% CI 0.98-1.68） 更明显（交互作用 p = 0.006）。结论计算机断层扫描 SMI 定义的肌肉质量减少与 CABG 后的长期死亡率相关。这些结果提供了当代数据，以便在手术前评估晚期冠状动脉疾病患者的身体虚弱程度。试验注册： 接受 CABG 或 PCI 患者的长期结局和预后因素： NCT03870815