Association between body composition phenotypes and cardiovascular outcomes in patients with coronary artery disease: a retrospective cohort study.

The prognostic value of body composition phenotypes in coronary artery disease (CAD) remains underexplored. We retrospectively analyzed 178 CAD inpatients who underwent bioelectrical impedance analysis (InBody 770). K-means clustering using skeletal muscle index (SMI) and body fat percentage (PBF) as primary discriminators identified three phenotypes: Sarcopenic (lowest SMI, ~5.3 kg/m²), Robust (highest SMI, ~7.6 kg/m²), and Sarcopenic-Obesity (low SMI ~ 5.8 kg/m² and high PBF ~ 36.9%). Multivariate logistic regression assessed their associations with cardiovascular outcomes. The Sarcopenic-Obesity phenotype showed the highest prevalence of arrhythmias (39.6%) and heart failure (62.5%) and was independently associated with arrhythmias (OR 2.58, 95% CI 1.17-5.87) and heart failure (OR 2.42, 95% CI 1.18-5.21). Phase angle inversely correlated with ECW/TBW (r = -0.83, p < 0.001) and discriminated heart failure (AUC = 0.72). Body composition phenotyping, especially sarcopenic obesity, identifies high-risk CAD inpatients beyond traditional factors.