Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease

Ning ZHANG; Wen-Ling ZHU; Xiao-Hong LIU; Wei CHEN; Ming-Lei ZHU; Lin KANG; Ran TIAN

doi:10.11909/j.issn.1671-5411.2019.10.002

摘要：Background Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes,including falls,fractures,physical disability,and mortality.However,there have been few systematic studies of the prevalence and prognostic values of sarcopenia in older patients with coronary heart disease (CHD).This study aimed to investigate the prevalence of sarcopenia in hospitalized older patients with CHD,and to prospectively evaluate the effect of sarcopenia on the short-term prognosis of these patients.Methods Patients aged ≥ 65 years,with the diagnosis of CHD from Peking Union Medical College Hospital between December 2017 and November 2018,were included.Sarcopenia was diagnosed according to consensus of the Asian Working Group for Sarcopenia in 2014.Follow-up items included unscheduled return visits,occurrence of major adverse cardiac and cerebral events (MACCE),and all-cause mortality.The MACCE-free survival curve of sarcopenic and non-sarcopenic older patients with CHD was estimated by the Kaplan-Meier method.Cox regression analysis was used to analyze the association between sarcopenia and an unscheduled return visits,MACCE,and all-cause mortality.Results A total of 345 older patients with CHD were enrolled in the study,with a median age of 74 years.Among the patients,78 (22.6％) were diagnosed with sarcopenia.During the follow-up time,there were significantly more unscheduled return visits in sarcopenic patients than in non-sarcopenic patients (34.2％ vs.21.8％,x2 =4.418,P =0.036),while there was no significant difference in the occurrence of MACCE (x2 =2.869,P =0.09) or all-cause mortality (x2 =1.673,P =0.196) between these patient groups.The Kaplan-Meier curve showed that the MACCE-free survival time of sarcopenic patients was significantly shorter than that in non-sarcopenic patients (x2 =4.102,P =0.043).After adjusting for sex,age,and the Charlson comorbidity index,sarcopenia was not an independent risk factor of unscheduled return visits (HR =1.002,95％ CI:0.556-1.807).However,the complication of anxiety and depression was an independent risk factor (HR =1.876,95％ CI:1.012-3.477,P =0.046) for unscheduled return visits in older patients with CHD.Conclusions There is a high prevalence of sarcopenia among hospitalized older adults with CHD.A shorter MACCE-free survival time and more unscheduled retum visits are found in sarcopenic older patients with CHD.Clinicians should pay more attention to the functional status of older patients with CHD,as well as identification and management of geriatric syndromes.