The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry
The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry
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DOI：
10.1016/j.jcin.2017.03.013
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发表时间：
2017-07-10
影响因子：
11.3
通讯作者：
Mamas, Mamas A.
中科院分区：
文献类型：
--
作者：
Holroyd, Eric W.;Sirker, Alex;Mamas, Mamas A.
目的 本研究的目的是检查体重指数 (BMI) 与经皮冠状动脉介入治疗 (PCI) 后临床结果之间的关系，并确定需要 PCI 的不同临床表现与这种关系的相关性。 背景 肥胖是一个日益严重的问题，研究报告了与正常 BMI 相比，肥胖对 PCI 后不良结果的保护作用。 方法 2005 年至 2013 年期间，纳入了 345,192 名参与者。数据来自英国心血管干预协会登记处，死亡率数据来自英国国家统计局。采用多元逻辑回归来确定 BMI 组 (30 kg/m(2)) 与不良院内结局和死亡率之间的关联。 结果 PCI 后 30 天，BMI 升高的患者死亡率显着降低（比值比 [OR]：0.86 [95% 置信区间 (CI)：0.80 至 0.93] 0.90 [95% CI：0.82 至 0.98] BMI 分别为 25 至 30 和 > 30 kg/m(2)）。 PCI 术后 1 年以及 PCI 术后 5 年，与正常体重相比，BMI 升高（超重或肥胖）是生存率较高的独立预测因素（1 年 OR：0.70 [95% CI：0.67 至 0.73] 和 0.73 [95% CI：0.69 至 0.77]；OR：0.78 [95% CI： 5 年分别为 0.75 至 0.81] 和 0.88 [95% CI：0.84 至 0.92]）。根据临床表现（稳定型心绞痛、不稳定型心绞痛或非 ST 段抬高型心肌梗死以及 ST 段抬高型心肌梗死）进行分析，观察到类似的死亡率降低。 结论 在当代英国实践中，关于 BMI 升高与 PCI 后死亡率降低的独立关联的悖论仍然很明显。这在稳定和更急性的临床环境中都可以看到。 (C) 2017 年，美国心脏病学会基金会。
OBJECTIVES The aims of this study were to examine the relationship between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI) and to determine the relevance of different clinical presentations requiring PCI to this relationship.BACKGROUND Obesity is a growing problem, and studies have reported a protective effect from obesity compared with normal BMI for adverse outcomes after PCI.METHODS Between 2005 and 2013, 345,192 participants were included. Data were obtained from the British Cardiovascular Intervention Society registry, and mortality data were obtained through the U.K. Office of National Statistics. Multiple logistic regression was performed to determine the association between BMI group (30 kg/m(2)) and adverse in-hospital outcomes and mortality.RESULTS At 30 days post-PCI, significantly lower mortality was seen in patients with elevated BMIs (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.80 to 0.93] 0.90 [95% CI: 0.82 to 0.98] for BMI 25 to 30 and > 30 kg/m(2), respectively). At 1 year post-PCI, and up to 5 years post-PCI, elevated BMI (either overweight or obese) was an independent predictor of greater survival compared with normal weight (OR: 0.70 [95% CI: 0.67 to 0.73] and 0.73 [95% CI: 0.69 to 0.77], respectively, for 1 year; OR: 0.78 [95% CI: 0.75 to 0.81] and 0.88 [95% CI: 0.84 to 0.92], respectively, for 5 years). Similar reductions in mortality were observed for the analysis according to clinical presentation (stable angina, unstable angina or non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction).CONCLUSIONS A paradox regarding the independent association of elevated BMI with reduced mortality after PCI is still evident in contemporary U.K. practice. This is seen in both stable and more acute clinical settings. (C) 2017 by the American College of Cardiology Foundation.