Oreopoulos Antigone, Padwal Raj, Norris Colleen M, Mullen John C, Pretorius Victor, Kalantar-Zadeh Kamyar
Division of Cardiothoracic Surgery, University of Alberta, Edmonton, Alberta, Canada.
Obesity (Silver Spring). 2008 Feb;16(2):442-50. doi: 10.1038/oby.2007.36.
Overweight and obesity are often assumed to be risk factors for postprocedural mortality in patients with coronary artery disease (CAD). However, recent studies have described an "obesity paradox" -- a neutral or beneficial association between obesity and mortality postcoronary revascularization. We reviewed the effect of overweight and obesity systematically on short- and long-term all-cause mortality post-coronary artery bypass grafting (CABG) and post-percutaneous coronary intervention (PCI).
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify cohort, case control, and randomized controlled studies evaluating the effect of obesity on in-hospital/short-term (within 30 days) and long-term (up to 5 years) mortality. Full-text, published articles reporting all-cause mortality between individuals with and without elevated BMI were included. Two reviewers independently assessed studies for inclusion and performed data extraction.
Twenty-two cohort publications were identified, reporting results in ten post-PCI and twelve post-CABG populations. Compared to individuals with non-elevated BMI levels, obese patients undergoing PCI had lower short- (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.54-0.73) and long-term mortality (OR 0.65; 95% CI 0.51-0.83). Post-CABG, obese patients had lower short-term (OR 0.63; 95% CI 0.56-0.71) and similar long-term (OR 0.88; 95% CI 0.60-1.29) mortality risk compared to normal weight individuals. Results were similar in overweight patients for both procedures.
Compared to non-obese individuals, overweight and obese patients have similar or lower short- and long-term mortality rates postcoronary revascularization. Further research is needed to confirm the validity of these findings and delineate potential underlying mechanisms.
超重和肥胖通常被认为是冠状动脉疾病（CAD）患者术后死亡的危险因素。然而，最近的研究描述了一种“肥胖悖论”——肥胖与冠状动脉血运重建术后死亡率之间存在中性或有益的关联。我们系统回顾了超重和肥胖对冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）后短期和长期全因死亡率的影响。
我们检索了Cochrane对照试验中心注册库、MEDLINE、EMBASE、Scopus和Web of Science，以识别评估肥胖对住院/短期（30天内）和长期（长达5年）死亡率影响的队列研究、病例对照研究和随机对照研究。纳入了报告BMI未升高和升高个体之间全因死亡率的全文发表文章。两名审稿人独立评估研究是否纳入并进行数据提取。
确定了22篇队列研究出版物，报告了10个PCI术后和12个CABG术后人群的结果。与BMI未升高的个体相比，接受PCI的肥胖患者短期（比值比（OR）0.63；95%置信区间（CI）0.54 - 0.73）和长期死亡率较低（OR 0.65；95% CI 0.51 - 0.83）。CABG术后，与正常体重个体相比，肥胖患者短期死亡率风险较低（OR 0.63；95% CI 0.56 - 0.71），长期死亡率风险相似（OR 0.88；95% CI 0.60 - 1.29）。两种手术的超重患者结果相似。
与非肥胖个体相比，超重和肥胖患者冠状动脉血运重建术后的短期和长期死亡率相似或更低。需要进一步研究以证实这些发现的有效性并阐明潜在的潜在机制。
