Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death
Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death
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DOI：
10.1016/j.ijcard.2005.06.040
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发表时间：
2006-06-16
影响因子：
3.5
通讯作者：
Jaffe, Allan S.
中科院分区：
文献类型：
--
作者：
Nigam, Anil;Wright, R. Scott;Jaffe, Allan S.
目的：探讨体重指数(BMI)升高对急性心肌梗死(AMI)患者近期和长期生存的影响。背景：最近的研究表明，与正常体重的患者相比，接受经皮冠状动脉介入治疗的肥胖患者30天和1年的结果更好，这是一个肥胖症生存悖论。我们对急性心肌梗死后类似的肥胖悖论假说进行了检验。方法：根据1988年1月1日至2001年4月16日梅奥临床冠脉护理病房收治的894名80岁以上的急性心肌梗死患者的体重指数状况，评估短期和长期全因死亡率和再发急性心肌梗死风险。正常体重、超重和肥胖定义为BMI；25、25-29.9和30 kg/m(2)。结果：过夜和肥胖患者出院后的总死亡率显著低于正常体重患者，这主要归因于与正常体重患者相比，6个月死亡率更低(BMI和GT调整后HR=0.47，P=0.01；25 kg/m(2))，而6个月幸存者的长期死亡率在所有3组中都是相似的。BMI+GT；25 kg/m(2)组再发心肌梗死的风险较高(校正后HR-2.30，P=0.01)。超重和肥胖患者明显更有可能死于心脏原因，而不是非心脏原因(P<；0.01)。结论：在急性心肌梗死后，超重和肥胖患者虽然矛盾地避免了短期死亡，但长期死亡风险与正常体重的人相似。首次发病时年龄较小和较少的非心血管并发症可能解释了心肌梗死后短暂的肥胖生存悖论。(C)2005爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: To evaluate the influence of elevated body mass index (BMI) oil short- and long-term survival following acute myocardial infarction (AMI). Background: Recent studies suggest an obesity survival paradox in individuals undergoing percutaneous coronary intervention with better 30-day and 1-year outcomes in obese relative to normal weight patients. We tested a similar obesity paradox hypothesis following acute myocardial infarction.Methods: Short- and long-term all-cause mortality, and risk Of recurrent AMI were evaluated according to BMI status in 894 consecutive survivors of AMI < 80 years of age admitted to the Mayo Clinic Coronary Care Unit between January 1 1988 and April 16, 2001. Normal weight, overweight and obesity were defined as BMI < 25, 25-29.9 and > 30 kg/m(2). respectively.Results: Overall mortality following hospital discharge was significantly lower in overnight and obese patients and was mostly attributable to lower 6-month mortality (adjusted HR = 0.47, P = 0.01 for BMI > 25 kg/m(2)) relative to normal weight patients, while long-term mortality among 6-month survivors was similar in all 3 groups. The risk of recurrent AMI was hi.-her in patients with BMI > 25 kg/m(2) (adjusted HR-2.30, P=0.01). Overweight and obese patients Nvere significantly more likely to die from cardiac rather than noll-cardiac causes (P < 0.01).Conclusions.- Following AMI, overweight and obese individuals althoul-Ai paradoxically protected from short-term death have a long-term mortality risk that is similar to nomial weight individuals. Younger age at the time of initial infarction and fewer non-cardiovascular comorbidities presumably explain the short-lived obesity survival paradox following myocardial infarction. (c) 2005 Elsevier Ireland Ltd. All rights reserved.