P1729Low skeletal muscle mass is associated with poor cardiovascular outcome in patients after ST-segment elevation myocardial infarction

Introduction: Loss of skeletal muscle mass is associated with diabetes, insulin resistance, inflammation, and generalized atherosclerosis. The angiographic complexity of coronary artery disease can predict outcomes in patients undergoing percutaneous coronary intervention. However, the relationship between skeletal muscle mass and ST-segment elevation myocardial infarction (STEMI) remains undetermined. Hypothesis: We assessed the hypothesis that low appendicular skeletal muscle mass index (ASMI) is associated with high coronary plaque complexity in patients with STEMI. Methods: We enrolled consecutive 112 patients with STEMI (age 64±12, male 87.5%) in this study. Appendicular skeletal muscle mass was estimated from dual-energy X-ray absorptiometry (DXA) scan before discharge and ASMI was defined as appendicular skeletal muscle mass divided by height squared (kg/m 2 ). ASMI was dichotomized according to the Asia Working Group for Sarcopenia criteria, which determined low (<7.0 kg/m 2 for men and <5.4 kg/m 2 for women by DXA) and normal ASMI. And we graded the coronary plaque complexity by using the Synergy between Percutaneous Coronary Intervention with Taxus and Coronary Surgery (SYNTAX) score at the initial coronary angiography. Result: ASMI correlated positively with body mass index (r=0.80, P<0.001), as well as negatively with age (r=-0.63, P<0.001), SYNTAX score (r=-0.28, P=0.003), Killip classification (r=-0.22, P=0.019), and B-type natriuretic peptide levels on admission (r=-0.27, P=0.014). The prevalence of low ASMI patients was 41% (n=46). Low ASMI patients had higher SYNTAX score (19.0±8.3 versus 13.7±7.7, P=0.001) compared with normal ASMI patients. Multivariate logistic regression analysis including age, gender and various classical risk factors demonstrated that ASMI significantly and independently correlated with moderate-severe coronary plaque complexity (SYNTAX score>22, n=22) in STEMI patients (odds ratio per 1: 0.55, 95%-confidence interval: 0.35-0.87, P=0.01). Conclusion: Low ASMI is significantly associated with high coronary plaque complexity in patients with STEMI, suggesting that skeletal muscle mass could play a crucial role in the pathogenesis of atherosclerosis in patients with STEMI.

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P5483Prognostic impact of skeletal muscle, fat, and bone mass in male patients with ST-segment elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0437 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Satou ◽

E Akiyama ◽

M Konishi ◽

Y Matsuzawa ◽

Y Kimura ◽

...

Keyword(s):

Myocardial Infarction ◽

Skeletal Muscle ◽

Bone Mass ◽

Composite Outcome ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Bone Mass Index ◽

Male Patients ◽

Primary Composite Outcome

Abstract Introduction Muscle, fat and bone mass may play some roles to keep physical activity and favorable outcome in patients with cardiovascular diseases. However, there is a paucity of data regarding the effects on the prognosis of skeletal muscle, fat, and bone mass in patients with ST-segment elevation myocardial infarction (STEMI). Purpose Our purpose was to examine whether skeletal muscle, fat, and bone mass each affect the prognosis after STEMI. Methods A total of 354 male patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. 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 During a median follow-up of 32 months, 57 patients experienced primary composite outcome. Each of skeletal muscle, fat, and bone mass were indexed by height squared (kg/m2) and divided into two groups using the cut-off value obtained from the maximum Youden index to predict the primary composite outcome. The event rate was significantly higher in patients with low appendicular skeletal muscle mass index (ASMI) (29.2% vs 11.7%, p<0.001), low fat mass index (FMI) (22.9% vs 13.3%, p=0.030), and low bone mass index (23.8% vs 11.6%, p=0.002). After adjustment for age, renal function, diabetes mellitus, infarct size, Killip classification, and body mass index, low ASMI but not FMI (p=0.150) and bone mass index (p=0.159) was independently and significantly associated with the primary composite outcome (adjusted hazard ratio 2.12, 95%-confidence interval 1.05–4.31, p=0.035). Conclusions Index about muscle mass rather than fat and bone mass have prognostic impact in male patients with STEMI.

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Prognostic Value of Psoas Muscle Mass Index in Patients With Non‒ST‐Segment‒Elevation Myocardial Infarction: A Prospective Observational Study

Journal of the American Heart Association ◽

10.1161/jaha.120.017315 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Hiroshi Matsumoto ◽

Koichiro Matsumura ◽

Yoshihiro Yamamoto ◽

Kenichi Fujii ◽

Satoshi Tsujimoto ◽

...

Keyword(s):

Myocardial Infarction ◽

Muscle Mass ◽

Cardiovascular Events ◽

Prognostic Value ◽

Muscle Wasting ◽

Psoas Muscle ◽

Receiver Operating Curve ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Background Muscle wasting is an important predictor of long‐term outcome in patients with cardiovascular disease, but the prognostic value of muscle wasting in patients with non‒ST‐segment‒elevation myocardial infarction is not established. The aim of this study is to investigate the prognostic value of muscle wasting, defined by psoas muscle mass index (PMI), in patients with non‒ST‐segment‒elevation myocardial infarction. Methods and Results A total of 132 consecutive patients with non‒ST‐segment‒elevation myocardial infarction were prospectively enrolled between 2015 and 2018. Primary end point was incidence of cardiovascular events including cardiovascular deaths, non‐fatal myocardial infarction, or non‐fatal stroke. Cross‐sectional area of the psoas muscle at the L3 vertebral level was obtained by computed tomography and PMI was calculated. The median follow‐up period was 2.4 years (interquartile range, 1.1–4.0 years). There were 45 cardiovascular events (34%) during the study periods. The optimal cutoff value of PMI to predict cardiovascular events was 772 mm 2 /m 2 , as assessed by receiver operating curve analysis. Patients with reduced PMI (PMI<772 mm 2 /m 2 ) had significantly higher cardiovascular events than those with preserved PMI (PMI≥772 mm 2 /m 2 ) (48% versus 21%; log‐rank test P <0.001). Multivariate Cox proportional hazards model revealed that reduced PMI was a statistically significant predictor of cardiovascular events (hazard ratio, 3.30; 95% CI, 1.70–6.40; P <0.001). Conclusions Muscle wasting defined as PMI is a simple and useful objective marker to predict future cardiovascular outcome in patients with non‒ST‐segment‒elevation myocardial infarction. Registration Information URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000013445.

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Efficacy of Quantitative Troponin I in Predicting Cardiovascular Outcome in ST Segment Elevation Myocardial Infarction / Non-ST Segment Elevation Myocardial Infarction (STEMI / NSTEMI) Patients - A Retrospective Study from a Centre in South India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/171 ◽

2021 ◽

Vol 8 (14) ◽

pp. 877-881

Author(s):

Jisa George ◽

Malathy A.R

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Retrospective Analysis ◽

Troponin I ◽

Left Ventricular ◽

Cardiovascular Outcome ◽

Ventricular Failure ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

BACKGROUND Cardiac biomarkers like troponin play a very important role in the diagnosis of acute myocardial infarction. In a developing country like India, though the burden of cardiovascular diseases is on the rise, majority of the patients with acute coronary syndrome do not have access to primary percutaneous coronary intervention (PCI) facilities. Few Indian studies have looked into the utility of the quantitative troponin levels in predicting the cardiovascular outcome of non-ST segment elevation myocardial infarction / ST segment elevation myocardial infarction STEMI / NSTEMI patients; this study was conducted to find out the same. METHODS A retrospective analysis of the medical records of intensive care units (ICU) patients more than 18 years of age admitted with diagnosis of STEMI / NSTEMI for a duration of 12 months was done. The comorbidities, treatment, coronary artery disease (CAD) risk factors, cardiovascular complications and quantitative troponin levels were noted. RESULTS Retrospective analysis of 124 patient records was done which revealed that 74.8 % presented with STEMI and the rest were diagnosed to have NSTEMI. 39.5 % were hypertensive and 47 % were diabetic. The mean troponin values were higher in the patients who died and developed cardiac complications like left ventricular failure and cardiogenic shock. However, statistical significance was seen only for troponin values and left ventricular failure (LVF). CONCLUSIONS The quantitative levels of a simple biomarker like troponin I used for the diagnosis of acute myocardial infarction could also be used to predict the cardiovascular outcome and prognosis of the patient. A higher baseline troponin value during the diagnosis could possibly alert the treating primary physician for a referral to a specialised cardiac centre and likely need for early revascularisation, which is of importance in a developing country like India with compromised resources. KEYWORDS Quantitative Troponin I, STEMI, NSTEMI

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