ArticleFrontiers in cardiovascular medicine2026
Association of skeletal muscle index and intermuscular adipose tissue index measured by non-contrast chest CT with major adverse cardiovascular events in patients with coronary artery disease: a nested case-control study in a Chinese population.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the association between chest CT-derived body composition indices and major adverse cardiovascular events (MACE) in coronary artery disease (CAD) patients, and to evaluate their utility for risk stratification. Materials and methods: This nested case-control study was drawn from a consecutive cohort of 2,226 patients with CAD diagnosed by coronary CT angiography (CCTA) between January 2019 and March 2021. During follow-up, 275 patients developed MACE and were included as cases. From the remaining non-MACE cohort members, 275 controls were selected by simple random sampling, yielding a total of 550 patients. Areas of subcutaneous adipose tissue (SAT), skeletal muscle (SM), intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) at the T8 level were segmented on non-contrast chest CT with 3D Slicer, and the corresponding indices and the muscle-to-fat ratio (MSFR) were derived. Associations with MACE were assessed with an inverse-probability-of-sampling weighted Cox proportional-hazards model (robust variance) with pre-specified confounder adjustment, testing of the proportional-hazards assumption, subgroup and interaction analyses, and restricted cubic spline (RCS) analysis. Results: A total of 550 patients with CAD were enrolled (275 per group). During a median follow-up of 18 months, 275 MACE events occurred. The MACE group had significantly lower skeletal muscle index (SMI) (37.99 vs. 41.27 cm²/m², Conclusion: Higher SMI was independently associated with a lower risk of MACE, whereas higher IMATI was independently associated with a higher risk. Skeletal muscle mass and intramuscular fat infiltration derived from non-contrast chest CT may serve as supplementary indicators for cardiovascular risk stratification in patients with CAD.
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