Okamura Homare, Kimura Naoyuki, Mieno Makiko, Yuri Koichi, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):121-129. doi: 10.1093/ejcts/ezz378.
We investigated the association between sarcopenia (a marker of frailty) and outcomes after coronary artery bypass grafting (CABG).
This study included 304 patients who underwent elective isolated off-pump CABG at our hospital between October 2008 and August 2013. Psoas muscle area was measured on preoperative computed tomography scans. Sarcopenia was defined as the lowest sex-specific quartile of the psoas muscle area index (the psoas muscle area normalized for height). Patients were categorized into a sarcopenia group (76 patients) and a non-sarcopenia group (228 patients). Patients in the sarcopenia group were older and showed a lower body mass index, lower serum haemoglobin and albumin levels and lower prevalence of dyslipidaemia but higher prevalence of renal dysfunction and peripheral artery disease. The mean follow-up period was 4.5 ± 2.3 years.
The cut-off values for sarcopenia were psoas muscle area index 215 and 142 mm2/m2 in men and women, respectively. No intergroup difference was observed in the in-hospital mortality and morbidity rates. After risk adjustment using inverse probability weighting analysis, late mortality rates were significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.022). Multivariable analysis showed that preoperative sarcopenia was an independent predictor of late mortality (hazard ratio 4.25, 95% confidence interval 2.18-8.28; P < 0.001). Preoperative sarcopenia was not associated with major adverse cardiac and cerebrovascular events during follow-up.
Preoperative sarcopenia (assessed by psoas muscle area index) was associated with late mortality after CABG and effectively predicts postoperative prognosis.
我们研究了肌肉减少症（一种虚弱的标志物）与冠状动脉旁路移植术（CABG）后结局之间的关联。
本研究纳入了2008年10月至2013年8月期间在我院接受择期非体外循环CABG的304例患者。术前通过计算机断层扫描测量腰大肌面积。肌肉减少症定义为腰大肌面积指数（根据身高标准化的腰大肌面积）的性别特异性最低四分位数。患者被分为肌肉减少症组（76例患者）和非肌肉减少症组（228例患者）。肌肉减少症组患者年龄较大，体重指数较低，血清血红蛋白和白蛋白水平较低，血脂异常患病率较低，但肾功能不全和外周动脉疾病患病率较高。平均随访期为4.5±2.3年。
男性和女性肌肉减少症的临界值分别为腰大肌面积指数215和142mm²/m²。两组间院内死亡率和发病率无差异。使用逆概率加权分析进行风险调整后，肌肉减少症组的晚期死亡率显著高于非肌肉减少症组（P = 0.022）。多变量分析显示，术前肌肉减少症是晚期死亡的独立预测因素（风险比4.25，95%置信区间2.18 - 8.28；P < 0.001）。术前肌肉减少症与随访期间的主要不良心脑血管事件无关。
术前肌肉减少症（通过腰大肌面积指数评估）与CABG后的晚期死亡率相关，并能有效预测术后预后。
