Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm
Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm
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DOI：
10.1007/s00380-021-01916-w
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发表时间：
2021-08
影响因子：
1.5
通讯作者：
N. Yoshioka;K. Takagi;A. Tanaka;Yasuhiro Morita;Ruka Yoshida;Hiroaki Nagai;Y. Kanzaki;Naoki Watanabe;R. Yamauchi;S. Komeyama;H. Sugiyama;K. Shimojo;T. Imaoka;G. Sakamoto;T. Ohi;Hiroki Goto;H. Ishii;I. Morishima;T. Murohara
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文献类型：
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作者：
N. Yoshioka;K. Takagi;A. Tanaka;Yasuhiro Morita;Ruka Yoshida;Hiroaki Nagai;Y. Kanzaki;Naoki Watanabe;R. Yamauchi;S. Komeyama;H. Sugiyama;K. Shimojo;T. Imaoka;G. Sakamoto;T. Ohi;Hiroki Goto;H. Ishii;I. Morishima;T. Murohara
在西方国家，低身体质量指数（BMI）是st段抬高型心肌梗死（STEMI）患者不良事件的预测指标。由于亚洲人的平均BMI明显低于西方人群，因此在亚洲患者中合适的BMI临界值及其在长期死亡率中的作用尚不清楚。2006年1月至2017年12月期间，1215例急性STEMI患者接受了经皮冠状动脉介入治疗（PCI），出院时存活（平均年龄67.7岁，男性，75.4%）。使用生存分类和回归树（CART）模型检测截止BMI值，该值可以预测10年内的全因死亡率。根据BMI值评估各组死亡原因。根据CART模型将患者分为BMI < 18kg /m2组54例，18 kg/m2≤BMI≤20kg /m2组109例，BMI > 20kg /m2组1052例。BMI随年龄增长而下降；随着体重指数的增加，血脂异常、糖尿病和吸烟习惯的患者增加。在研究期间（中位4.9年），194例（26.8%）患者死亡（心源性死亡59例，非心源性死亡135例）。BMI越低，全因死亡率越高（BMI < 18 kg/m2; 72.8%; 18 kg/m2≤BMI≤20 kg/m2; 40.5%; BMI≤20 kg/m2; 22.8%; log-rankp< 0.001）。在所有组中，非心源性死亡比心源性死亡更频繁，并且在BMI最低的组中，非心源性死亡的优势最大。BMI临界值18 kg/m2和20 kg/m2可以预测亚洲STEMI幸存者PCI术后的长期死亡率，其临界值低于西方人群。该队列的主要死亡原因因BMI值的不同而不同。
Low body mass index (BMI) is a predictor of adverse events in patients with ST-elevated myocardial infarction (STEMI) in Western countries. Because the average BMI of Asians is significantly lower than that of the Western population, the appropriate cut-off BMI value and its role in long-term mortality are unclear in Asian patients. Between January 2006 and December 2017, 1215 patients who underwent percutaneous coronary intervention (PCI) for acute STEMI and were alive at discharge (mean age, 67.7 years; male, 75.4%) were evaluated. The cut-off BMI value, which could predict all-cause mortality within 10 years, was detected using a survival classification and regression tree (CART) model. The causes of death according to the BMI value were evaluated in each group. Based on the CART model, the patients were divided into three groups (BMI < 18 kg/m2: 54 patients, 18 kg/m2≤ BMI ≤ 20 kg/m2: 109 patients, and BMI > 20 kg/m2: 1052 patients). The BMI decreased with age; with an increased BMI, patients with dyslipidemia, diabetes mellitus, and smoking habit increased. During the study period (median, 4.9 years), 194 patients (26.8%) died (cardiac death, 59 patients; non-cardiac death, 135 patients). All-cause mortality was more frequent as the BMI decreased (BMI < 18 kg/m2; 72.8%, 18 kg/m2≤ BMI ≤ 20 kg/m2; 40.5%, and BMI > 20 kg/m2; 22.8%; log-rankp< 0.001). Non-cardiac deaths were more frequent than cardiac deaths in all groups, and the dominance of non-cardiac death was highest in the lowest BMI group. Cut-off BMI values of 18 kg/m2and 20 kg/m2can predict long-term mortality after PCI in Asian STEMI survivors, whose cut-off value is lower than that in the Western populations. The main causes of death in this cohort differed according to the BMI values.