Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2010 Feb 15;105(4):475-9. doi: 10.1016/j.amjcard.2009.09.055. Epub 2010 Jan 5.
The aim of this analysis was to assess the effect of body mass index (BMI) on 1-year outcomes in patients enrolled in a contemporary percutaneous coronary intervention trial comparing a sirolimus-eluting stent with a durable polymer to a biolimus-eluting stent with a biodegradable polymer. A total of 1,707 patients who underwent percutaneous coronary intervention were randomized to treatment with either biolimus-eluting stents (n = 857) or sirolimus-eluting stents (n = 850). Patients were assigned to 1 of 3 groups according to BMI: normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 1 year, the incidence of the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was assessed. In addition, rates of clinically justified target lesion revascularization and stent thrombosis were assessed. Cox proportional-hazards analysis, adjusted for clinical differences, was used to develop models for 1-year mortality. Forty-five percent of the patients (n = 770) were overweight, 26% (n = 434) were obese, and 29% (n = 497) had normal BMIs. At 1-year follow-up, the cumulative rate of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was significantly higher in the obese group (8.7% in normal-weight, 11.3% in overweight, and 14.5% in obese patients, p = 0.01). BMI (hazard ratio 1.47, 95% confidence interval 1.02 to 2.14, p = 0.04) was an independent predictor of stent thrombosis. Stent type had no impact on the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization at 1 year in the 3 BMI groups (hazard ratio 1.08, 95% confidence interval 0.63 to 1.83, p = 0.73). In conclusion, BMI was an independent predictor of major adverse cardiac events at 1-year clinical follow-up. The higher incidence of stent thrombosis in the obese group may suggest the need for a weight-adjusted dose of clopidogrel.
本分析旨在评估体重指数（BMI）对接受经皮冠状动脉介入治疗的患者 1 年结果的影响，这些患者参与了一项比较雷帕霉素洗脱支架（带持久聚合物）与生物可吸收聚合物的依维莫司洗脱支架的当代经皮冠状动脉介入治疗试验。共有 1707 名接受经皮冠状动脉介入治疗的患者被随机分为生物可吸收支架（n=857）或雷帕霉素洗脱支架（n=850）治疗。根据 BMI 将患者分为 3 组：正常（<25kg/m²）、超重（25-30kg/m²）或肥胖（>30kg/m²）。1 年后，评估了心脏死亡、心肌梗死和临床有理由的靶血管血运重建的复合终点。此外，还评估了临床有理由的靶病变血运重建和支架血栓形成的发生率。采用 Cox 比例风险分析，根据临床差异调整模型，以预测 1 年死亡率。45%的患者（n=770）超重，26%（n=434）肥胖，29%（n=497）体重正常。在 1 年随访期间，肥胖组的心脏死亡、心肌梗死和临床有理由的靶血管血运重建的累积发生率显著更高（体重正常组为 8.7%，超重组为 11.3%，肥胖组为 14.5%，p=0.01）。BMI（风险比 1.47，95%置信区间 1.02 至 2.14，p=0.04）是支架血栓形成的独立预测因子。在 3 个 BMI 组中，支架类型对 1 年时的心脏死亡、心肌梗死和临床有理由的靶血管血运重建的复合终点无影响（风险比 1.08，95%置信区间 0.63 至 1.83，p=0.73）。总之，BMI 是 1 年临床随访时主要不良心脏事件的独立预测因子。肥胖组支架血栓形成的发生率较高可能表明需要根据体重调整氯吡格雷的剂量。
