Effect of sarcopenia on mortality in acute stroke patients receiving endovascular treatment

Abstract

Background: To investigate the effect of sarcopenia on mortality in patients with acute ischemic stroke caused by anterior circulation large artery occlusion who underwent endovascular treatment.

Methods: Acute ischemic stroke patients (n = 194) treated with mechanical thrombectomy who underwent chest computed tomography between 2019 and 2022 (median age, 69 [interquartile range: 61-77], 95 females, 99 males) were evaluated retrospectively. The cross-sectional area and density of the pectoralis muscle [pectoralis muscle area (PMA) and pectoralis muscle density (PMD)] at the level of the aortic arch and the erector spinae muscle at the T12 level [erector spinae muscle area (ESMA) and erector spinae muscle density (ESMD)] were measured. The association between skeletal muscle parameters and mortality outcomes was investigated using the receiver operating characteristic (ROC) curve and multivariable logistic regression analyses.

Results: The 90-day mortality rate was 32% in the study population (n = 62). The ROC analysis revealed that ESMD [area under the curve (AUC): 0.765] and PMD (AUC: 0.759) performed best in the prediction of 90-day mortality. In the multivariable logistic regression analysis, PMD [odds ratio (OR): 0.896; 95% confidence interval (CI): 0.846-0.948; p < 0.001], ESMA (OR: 0.929; 95% CI: 0.878-0.983; p = 0.011), and ESMD (OR: 0.947; 95% CI: 0.913-0.983; p = 0.004), but not PMA, were independent risk factors for 90-day mortality.

Conclusion: PMD, ESMA, and ESMD may be risk factors for 90-day mortality after mechanical thrombectomy for acute ischemic stroke.

Keywords: Sarcopenia; computed tomography; mechanical thrombectomy; stroke.

Figure 1.

Flow diagram describing patient selection.

Figure 2.

Computed tomography axial section measurement of cross-sectional area and muscle attenuation of the bilateral pectoralis major and minor muscles just above the aortic arch.

Figure 3.

Computed tomography examination of decreased bilateral pectoral muscle area and density (cross-sectional area: 12.3 cm2 and mean density: 23 Hounsfield unit).

Figure 4.

Computed tomography axial section measurement of the cross-sectional area and muscle attenuation of the bilateral erector spinae muscles at the level of the lower border of the 12th thoracic vertebra.

Figure 5.

Computed tomography analysis demonstrating decreased bilateral erector spinae muscle area and density at the level of T12 (cross-sectional area: 9.5 cm2 and mean density: −5 Hounsfield unit).

Figure 6.

Receiver operating characteristic analysis of skeletal muscle parameters for mortality prediction.