Kim Joseph, Hammar Niklas, Jakobsson Kristina, Luepker Russell V, McGovern Paul G, Ivert Torbjörn
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minn 55454, USA.
Am Heart J. 2003 Sep;146(3):555-60. doi: 10.1016/S0002-8703(03)00185-6.
Obesity is often considered to be a significant risk factor for postoperative mortality when selecting candidates for coronary artery bypass grafting (CABG).
We included all patients undergoing a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, between 1980 and 1995 (n = 6728). Patients were categorized on the basis of body mass index (BMI): non-overweight (BMI <25 kg/m2), overweight (25 kg/m2 < or = BMI <30 kg/m2), and obese (BMI > or =30 kg/m2). Multivariate Cox regression was used to assess the risk of re-operation for bleeding, deep sternal wound infection, and early (< or =30 days) and late (< or =5 years) mortality rates.
The average length of follow-up was 6.5 years. There were 252 re-operations for bleeding, 53 deep sternal wound infections, and 628 deaths. Patients who were obese had a significantly lower risk of re-operation for bleeding (risk ratio [RR], 0.32; 95% CI, 0.19-0.53), but a greater risk of deep sternal wound infection (RR, 2.66; 95% CI, 1.21-5.88) compared with patients who were not overweight. However, patients who were obese and patients who were not overweight experienced similar 30-day (RR, 0.65; 95% CI, 0.34-1.27), 1-year (RR, 0.56; 95% CI, 0.29-1.10), and 5-year mortality rates (RR, 0.91; 95% CI, 0.66-1.25). Results for patients who were overweight were consistent with those of patients who were obese.
Patients who are obese are not at a greater risk of early and late mortality after CABG compared with patients who are not overweight, although they appear to have a lower risk of re-operation for bleeding and a greater risk of deep sternal wound infection. Therefore, obesity per se is not a contraindication for CABG.
在选择冠状动脉旁路移植术（CABG）的候选患者时，肥胖常被视为术后死亡的重要危险因素。
我们纳入了1980年至1995年期间在瑞典斯德哥尔摩卡罗林斯卡医院接受首次单纯CABG手术的所有患者（n = 6728）。根据体重指数（BMI）对患者进行分类：非超重（BMI <25 kg/m²）、超重（25 kg/m²≤BMI <30 kg/m²）和肥胖（BMI≥30 kg/m²）。采用多变量Cox回归评估出血再次手术、深部胸骨伤口感染以及早期（≤30天）和晚期（≤5年）死亡率的风险。
平均随访时间为6.5年。有252例因出血进行再次手术，53例深部胸骨伤口感染，628例死亡。与非超重患者相比，肥胖患者出血再次手术的风险显著较低（风险比[RR]，0.32；95%置信区间，0.19 - 0.53），但深部胸骨伤口感染的风险更高（RR，2.66；95%置信区间，1.21 - 5.88）。然而，肥胖患者和非超重患者的30天（RR，0.65；95%置信区间，0.34 - 1.27）、1年（RR，0.56；95%置信区间，0.29 - 1.10）和5年死亡率相似（RR，0.91；95%置信区间，0.66 - 1.25）。超重患者的结果与肥胖患者一致。
与非超重患者相比，肥胖患者CABG术后早期和晚期死亡风险并不更高，尽管他们出血再次手术的风险似乎较低，而深部胸骨伤口感染的风险较高。因此，肥胖本身并非CABG的禁忌证。
