Key result
Preprocedural coronary microvascular dysfunction linked to ~2-fold higher MACE risk after cardiac surgery.
Why the study?
Thoracic intermuscular adiposity is related to coronary microvascular dysfunction, but their prognostic implications after cardiac surgery are unclear.
Does preprocedural coronary microvascular dysfunction or thoracic intermuscular adiposity independently predict MACE in patients undergoing elective cardiac surgery better than body mass index?
Cohort (n=666)
Yes
Does preprocedural coronary microvascular dysfunction or thoracic intermuscular adiposity independently predict MACE in patients undergoing elective cardiac surgery better than body mass index?
Hazard Ratio: 2.03 (95% CI 1.15–3.61)
Absolute Event Rate: 11% vs 5.2%
p-value: p=0.015
Preprocedural coronary microvascular dysfunction, rather than computed tomography-derived intermuscular adiposity or body mass index, is an independent predictor of major adverse cardiovascular events following elective cardiac surgery.
CMD was associated with higher post-cardiac surgery MACE risk independent of BMI; hypothesis-generating and warrants prospective validation.
Background Body mass index is a widely‐used yet imprecise measure of adiposity. Thoracic intermuscular adiposity is reported to be related with coronary microvascular dysfunction (CMD), but their prognostic implications after cardiac surgery are not clear. This study aimed to investigate whether computed tomography–derived thoracic intermuscular adiposity and CMD provide better prognostic information than body mass index in patients undergoing cardiac surgery. Methods This study consecutively enrolled 666 patients undergoing elective surgery from 3 centers. Using computed tomography at the T12 vertebral level, we quantified the cross‐sectional areas (cm 2 ) of skeletal muscle, subcutaneous adipose tissue, and intermuscular adipose tissue. Intermuscular fat fraction was calculated as intermuscular adipose tissue/(intermuscular adipose tissue+skeletal muscle)×100%. CMD was defined by a coronary angiography‐derived index of microcirculatory resistance >25. The primary end point was major adverse cardiovascular events (MACE), a composite of all‐cause mortality, myocardial infarction, and rehospitalization for heart failure. Results A total of 63 MACEs (9.5%) occurred during a median 17‐month follow‐up. Obesity defined by body mass index (10.7% of patients) was not associated with MACE ( P =0.187). Each 1% increase in intermuscular fat fraction was significantly associated with CMD (adjusted odds ratio, 1.22 [95% CI, 1.14–1.31]; P <0.001), whereas body mass index showed no such correlation ( P =0.964). CMD independently predicted MACE (adjusted hazard ratio, 2.03; [95% CI: 1.15–3.61]; P = 0.015), whereas intermuscular fat fraction did not ( P =0.516). The annualized MACE rate was significantly higher in patients with CMD (11.0% versus 5.2%, P =0.004). Conclusions Computed tomography‐derived intermuscular adiposity correlated strongly with CMD, and preprocedural CMD was associated with a higher risk of MACE after cardiac surgery. External validation and prospective studies are warranted.
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Zhou et al. (2026) conducted a cohort in Elective cardiac surgery (n=666). Coronary microvascular dysfunction (CMD) vs. Patients without CMD was evaluated on Major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction, and rehospitalization for heart failure (HR 2.03, 95% CI 1.15-3.61, p=0.015). Preprocedural coronary microvascular dysfunction was associated with a higher risk of MACE after cardiac surgery (annualized rate 11.0% vs 5.2%; HR 2.03, 95% CI 1.15-3.61; P=0.015).
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