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Objective Few studies have investigated the association between cardiorespiratory fitness (CRF) impairment and coronary artery disease (CAD) and the mediating mechanism. Therefore, we investigated the impact of skeletal muscle mass (SMM) on the relationship between CRF and coronary artery disease (CAD) in elderly people. Methods In this cross-sectional study, 109 elderly patients with coronary artery stenosis ≥50% were included in the CAD group, and 148 patients with coronary artery stenosis less then 50% were included as controls. Media