Ndrepepa Gjin, Keta Dritan, Byrne Robert A, Schulz Stefanie, Mehilli Julinda, Seyfarth Melchior, Schömig Albert, Kastrati Adnan
Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, 80636 Munich, Germany.
Heart Vessels. 2010 Jan;25(1):27-34. doi: 10.1007/s00380-009-1160-3. Epub 2010 Jan 21.
Studies that have tested the relationship between body weight as assessed by body mass index (BMI) and clinical outcome after percutaneous coronary intervention (PCI) have given contradictory results. The aim of the study was to investigate the impact of BMI on clinical outcome and assess the impact of adjustment for other cardiovascular risk factors on the relationship between obesity and clinical outcome in patients with acute coronary syndromes (ACS) following PCI. This study included 9146 patients with ACS who underwent coronary angiography and PCI: 2610 patients with ST-segment elevation acute myocardial infarction, 2792 patients with non-ST-segment elevation acute myocardial infarction, and 3744 patients with unstable angina. The primary outcome of this analysis was 1-year mortality. Quartiles of BMI were: 12.8 to <24.3 (1st quartile), 24.3 to <26.4 (2nd quartile), 26.4 to <29.1 (3rd quartile), and >29.1 to 50.7 (4th quartile). Within the first year following PCI, there were 756 deaths: 228 deaths in the 1st BMI quartile, 209 deaths in the 2nd BMI quartile, 161 deaths in the 3rd BMI quartile and 158 deaths in the 4th BMI quartile (Kaplan-Meier estimates of mortality 10.3%, 9.1%, 7.2%, and 7.0%, respectively; odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.22-1.86, P < 0.001 for 1st vs 4th BMI quartile). After adjustment in the Cox proportional hazards model, the association between BMI and 1-year mortality was attenuated to the level of statistical insignificance (hazards ratio [HR] = 1.25, 95% CI 0.94-1.64; P = 0.127 for 1st vs 4th BMI quartile). In conclusion, in patients with ACS undergoing PCI, obesity as assessed with BMI was not an independent correlate of 1-year mortality.
一些研究检测了通过体重指数（BMI）评估的体重与经皮冠状动脉介入治疗（PCI）后临床结局之间的关系，但结果相互矛盾。本研究的目的是调查BMI对临床结局的影响，并评估在PCI后的急性冠状动脉综合征（ACS）患者中，调整其他心血管危险因素对肥胖与临床结局之间关系的影响。本研究纳入了9146例接受冠状动脉造影和PCI的ACS患者：2610例ST段抬高型急性心肌梗死患者、2792例非ST段抬高型急性心肌梗死患者和3744例不稳定型心绞痛患者。该分析的主要结局是1年死亡率。BMI的四分位数分别为：12.8至<24.3（第一四分位数）、24.3至<26.4（第二四分位数）、26.4至<29.1（第三四分位数）和>29.1至50.7（第四四分位数）。在PCI后的第一年内，有756例死亡：第一BMI四分位数中有228例死亡，第二BMI四分位数中有209例死亡，第三BMI四分位数中有161例死亡，第四BMI四分位数中有158例死亡（Kaplan-Meier估计的死亡率分别为10.3%、9.1%、7.2%和7.0%；第一与第四BMI四分位数的比值比[OR]=1.51，95%置信区间[CI]为1.22-1.86，P<0.001）。在Cox比例风险模型中进行调整后，BMI与1年死亡率之间的关联减弱至无统计学意义的水平（风险比[HR]=1.25，95%CI为0.94-1.64；第一与第四BMI四分位数的P=0.127）。总之，在接受PCI的ACS患者中，用BMI评估的肥胖并非1年死亡率的独立相关因素。
