J Clin Med. 2020;9(10):jcm9103121.

Sarcopenia Index as a Predictor of Clinical Outcomes in Older Patients with Coronary Artery Disease.

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제1저자 이학승 · 교신저자 박경우

PMID 32992530 PMC7600792 DOI 10.3390/jcm9103121 IF 3.3 순환기내과

소속 (1)

Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea.

Abstract

To demonstrate the association of the serum creatinine/serum cystatin C ratio (sarcopenia index, SI) with clinical outcomes including cardiovascular and bleeding risk in older patients who underwent percutaneous coronary intervention (PCI), we analyzed a multicenter nation-wide pooled registry. A total of 1086 older patients (65 years or older) who underwent PCI with second-generation drug-eluting stents (DES) were enrolled. The total population was divided into quartiles according to the SI, stratified by sex. The primary clinical outcomes were major adverse cardiovascular events (MACE, all-cause death, myocardial infarction and target lesion revascularization) and thrombolysis in myocardial infarction major and minor bleeding during a 3-year follow-up period. In the total population, MACE occurred within 3 years in 154 (14.2%) patients. The lowest SI quartile group (Q1) had a significantly higher 3-year MACE rate (Q1 vs. Q2-4; 23.1% vs. 11.2%, p < 0.001), while bleeding event rates were similar between the groups (Q1 vs. Q2-4; 2.6% vs. 2.2%, p = 0.656). The Cox proportional hazard model showed that lower SI is an independent predictor for MACE events (HR 2.23, 95% CI 1.62-3.07, p < 0.001). The SI, a surrogate for the degree of muscle mass, is associated with cardiovascular and non-cardiovascular death, but not with bleeding in older patients who underwent PCI.

Keywords

creatininecystatin Cpercutaneous coronary interventionsarcopenia

Figures

**Figure 1** Study flow of the nested sub-cohort. The Grand drug-eluting stents (DES) registry is a multicenter nation-wide pooled registry of the EXCELLENT registry, HOST-PRIME registry, RESOLUTE-Korea registry, RESOLINTE registry, and HOST-BIOLIMUS registry in Korea. Among the total population of the Grand DES registry, 1086 patients who had serum creatinine and cystatin C data and aged 65 or older were analyzed in this study. DES = drug-eluting stent.

**Figure 2** Different distributions of sarcopenia index depending on sex. Sarcopenia index (SI) ranged from 0.39 to 2.39 (median 1.04, interquartile range (IQR) 0.89–1.19). SI was distributed differently depending on sex; the mean SI was 1.11 (IQR 1.00–1.26) in men and 0.89 (IQR 0.78–1.02) in women (p < 0.001). SI = sarcopenia index; IQR = interquartile range.

**Figure 3** Cumulative incidence of events with quartiles of sarcopenia index. Overall, the lowest quartile group had a higher major advance cardiovascular event (MACE) rate, while there were no significant differences in bleeding events. SI = sarcopenia index; MACE = major advance cardiovascular event; PCI = percutaneous coronary intervention; HR = hazard ratio; CI = confidence interval.

**Figure 4** Subgroup analysis for MACE. In subgroup analysis, the poor prognosis of the Q1 group compared to that of the Q2–4 group was consistently observed across the various subgroups, without significant interaction. MACE = major adverse cardiovascular event; BMI = body mass index; DM = diabetes mellitus; HTN = hypertension; ACS = acute coronary syndrome; EF = ejection fraction. The following patient risk factors were included in the multivariate-adjusted Cox proportional hazard regression model: age, sex, body mass index, diabetes mellitus, hypertension, peripheral vascular disease, previous myocardial infarction (MI) or PCI, current smoking, previous congestive heart failure, clinical diagnosis, low EF, diseased vessel extent and total stent length.

그림 출처: PubMed Central 공개 논문 (PMC7600792)

Conflict of interest statement

The authors declare no conflict of interest.

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