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Impact of sarcopenic obesity on long-term clinical outcomes after ST-segment elevation myocardial infarction.

  • Sato, Ryosuke1
  • Okada, Kozo2
  • Akiyama, Eiichi1
  • Konishi, Masaaki3
  • Matsuzawa, Yasushi1
  • Nakahashi, Hidefumi1
  • Minamimoto, Yugo1
  • Kimura, Yuichiro1
  • Maejima, Nobuhiko1
  • Iwahashi, Noriaki1
  • Hibi, Kiyoshi1
  • Kosuge, Masami1
  • Ebina, Toshiaki1
  • Tamura, Kouichi3
  • Kimura, Kazuo1
  • 1 Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. , (Japan)
  • 2 Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. Electronic address: [email protected] , (Japan)
  • 3 Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, Yokohama, Japan. , (Japan)
Published Article
Publication Date
Aug 27, 2021
DOI: 10.1016/j.atherosclerosis.2021.08.038
PMID: 34517989


Both low appendicular skeletal muscle index (ASMI) and specific abdominal fat composition [i.e., increased visceral to subcutaneous (V/S) fat ratio] have been associated with cardiovascular events. However, the combined impact of these 2 components on long-term outcomes remains unclear, especially in patients with ST-segment elevation myocardial infarction (STEMI). In 303 patients with STEMI, ASMI and V/S fat ratio were assessed using dual-energy X-ray absorptiometry and abdominal computed tomography. Based on the criteria of the Asian Working Group for Sarcopenia and median of V/S fat ratio, sarcopenic obesity (SO) pattern was defined as low ASMI with high V/S fat ratio. The primary endpoint was composite outcomes of all-cause death, myocardial infarction, ischemic stroke, hospitalization for heart failure and unplanned revascularization. During a median follow-up of 3.9 years, primary endpoint occurred in 67 patients. Patients with an SO pattern showed significantly lower event-free survival rate compared with those without (p=0.006 by log-rank). Notably, when stratified by median age (67 years), this trend was particularly prominent in the younger-age group (p <0.001), but not significant in the older-age group (p=0.38). In the younger-age group, the multivariate analysis revealed that patients with SO pattern had a 2.97 (1.10-7.53) fold higher risk for primary endpoints compared with those without. Low ASMI with high V/S fat ratio, or so-called sarcopenic obesity, was associated with poor prognosis after STEMI, particularly in younger-age patients. The combined assessment of skeletal muscle with abdominal fat distribution may help stratify the risk among patients with STEMI, rather than each component alone. Copyright © 2021 Elsevier B.V. All rights reserved.

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