Quadriceps Strength as a Predictor of Mortality in Coronary Artery Disease

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• 作者：Kentaro Kamiya ; PT ; PhD^a ; ^{k-kamiya@kitasato-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takashi Masuda ; MD ; PhD^b ; ^c ; Shinya Tanaka ; PT ; MSc^b ; Nobuaki Hamazaki ; PT ; MSc^a ; ^b ; Yuya Matsue ; MD ; PhD^d ; Alessandro Mezzani ; MD ; FESC^e ; Ryota Matsuzawa ; PT ; PhD^a ; Kohei Nozaki ; PT ; MSc^a ; Emi Maekawa ; MD ; PhD^f ; Chiharu Noda ; MD ; PhD^f ; Minako Yamaoka-Tojo ; MD ; PhD^b ; ^c ; Yasuo Arai ; HIM ; MSc^g ; Atsuhiko Matsunaga ; PT ; PhD^b ; ^c ; Tohru Izumi ; MD ; PhD^f ; Junya Ako ; MD ; PhD^f
• 关键词：Coronary artery disease ; Muscle strength ; Prognosis
• 刊名：The American Journal of Medicine
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：128
• 期：11
• 页码：1212-1219
• 全文大小：774 K

文摘

The purpose of this study was to investigate the prognostic value of quadriceps isometric strength (QIS) in coronary artery disease (CAD).

Methods

The study population consisted of 1314 patients aged >30 years (64.7 ± 10.6 years, 1051 male) with CAD who were hospitalized for acute coronary syndrome or coronary artery bypass grafting. Maximal QIS was evaluated as a marker of leg strength and expressed relative to body weight (% body weight). The primary and secondary endpoints were all-cause death and cardiovascular (CV) death, respectively.

Results

During a mean follow-up of 5.0 ± 3.5 years, corresponding to 6537 person-years, there were 118 all-cause deaths and 63 CV deaths. A higher QIS remained associated with decreased all-cause mortality and CV mortality risks (hazard ratio for increasing 10% body weight of QIS 0.77, 95% confidence interval 0.67-0.89, P < .001 for all-cause death; hazard ratio 0.66, 95% confidence interval 0.54-0.82, P < .001 for CV death) after adjustment for other prognostic factors. The inclusion of QIS significantly increased both continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for all-cause death (cNRI: 0.25, P = .009; IDI: 0.007, P = .030) and CV death (cNRI: 0.34, P = .008; IDI: 0.013, P = .008).

Conclusions

A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.