Different approaches of strength-to-muscle mass ratio: impact on 24-month outcomes in patients with acute coronary syndrome

Objective This study aimed to evaluate the clinical impact of different approaches of strength-to-muscle mass ratio (i.e., adapted muscle-specific strength) and its components on 24-mo outcomes in acute coronary syndrome. Methods A prospective cohort study included adults aged ≥50 y. Three handgrip strength (HGS)-to-muscle mass markers ratios were evaluated: HGS to appendicular lean soft tissue (ALST), HGS to calf circumference (CC), and HGS to adjusted calf circumference (adj-CC). Low index values were defined using the lowest sex-specific tertile: HGS/ALST (≤1.36 for males and ≤1.08 for females), HGS/CC (≤0.89 and ≤0.54), and HGS/adj-CC (≤0.97 and ≤0.58). Primary outcome was 24-mo all-cause mortality. Secondary outcomes included hospital readmission, cardiovascular-related readmission, new coronary events, percutaneous coronary intervention, and major adverse cardiovascular events (MACE). Results A total of 113 patients were included (58.4% male; mean age, 66 ± 9 y). HGS, HGS/CC, and HGS/adj-CC were inversely associated with nearly all secondary outcomes. The hazard ratio for 24-mo mortality was 0.90 per kg of HGS ( adjusted HR: 0.90; 95% CI: 0.82–0.96). HGS/CC and HGS/adj-CC were also inversely associated with mortality risk. All ratios predicted hospital readmission. Low HGS/ALST and low HGS/adj-CC were independent predictors of 24-mo mortality (HGS/ALST: adjusted HR, 3.87; 95% CI: 1.27–11.92; HGS/adj-CC: adjusted HR, 3.95; 95% CI: 1.26–12.35). Conclusion Our findings highlight the clinical relevance of assessing muscle strength in relation to (markers of) muscle mass. These ratios may provide additional prognostic value, reinforcing the importance of integrating muscle strength and mass assessments in patients with acute coronary syndrome.