Timóteo Ana Teresa, Ramos Ruben, Toste Alexandra, Oliveira José Alberto, Patrício Lino, Ferreira Maria Lurdes, Ferreira Rui Cruz
Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central EPE, Lisboa.
Rev Port Cardiol. 2010 Jun;29(6):999-1008.
Obesity is an important risk factor for the development of diabetes, hypertension, coronary disease, left ventricular dysfunction, stroke and cardiac arrhythmias. Paradoxically, previous studies in patients undergoing elective coronary angioplasty showed a reduction in hospital and long-term mortality in obese patients. The relation with body mass index (BMI) has been less studied in the context of primary angioplasty.
To evaluate the impact of obesity on the results of ST-segment elevation acute myocardial infarction treated by primary angioplasty.
This was a study of 464 consecutive patients with ST-segment elevation acute myocardial infarction undergoing primary angioplasty, 78% male, mean age 61 +/- 13 years. We assessed in-hospital, 30-day and one-year mortality according to BMI. Patients were divided into three groups according to BMI: normal--18-24.9 kg/m2 (n = 171); overweight--25-29.9 kg/m2 (n = 204); and obese-- > 30 kg/m2 (n = 89).
Obese patients were younger (ANOVA, p < 0.001) and more frequently male (p = 0.014), with more hypertension (p = 0.001) and dyslipidemia (p = 0.006). There were no differences in the prevalence of diabetes, previous cardiac history, heart failure on admission, anterior location, multivessel disease, peak total CK or medication prescribed, except that obese patients received more beta-blockers (p = 0.049). In-hospital mortality was 9.9% for patients with normal BMI, 3.4% for overweight patients and 6.7% for obese patients (p = 0.038). Mortality at 30 days was 11 4.4% and 7.8% (p = 0.032) and at one year 12.9%, 4.9% and 9% (p = 0.023), respectively. On univariate analysis, overweight was the only BMI category with a protective effect; however, after multivariate logistic regression analysis, adjusted for confounding variables, none of the BMI categories could independently predict outcome.
Overweight patients had a better prognosis after primary angioplasty for ST-segment elevation acute myocardial infarction compared with other BMI categories, but this was dependent on other potentially confounding variables.
肥胖是糖尿病、高血压、冠心病、左心室功能障碍、中风及心律失常发生的重要危险因素。矛盾的是，先前针对接受择期冠状动脉血管成形术患者的研究显示，肥胖患者的住院及长期死亡率有所降低。在直接血管成形术背景下，肥胖与体重指数（BMI）的关系研究较少。
评估肥胖对直接血管成形术治疗ST段抬高型急性心肌梗死结果的影响。
本研究纳入464例连续接受直接血管成形术的ST段抬高型急性心肌梗死患者，男性占78%，平均年龄61±13岁。我们根据BMI评估住院、30天及1年死亡率。患者按BMI分为三组：正常体重——18 - 24.9 kg/m²（n = 171）；超重——25 - 29.9 kg/m²（n = 204）；肥胖——> 30 kg/m²（n = 89）。
肥胖患者更年轻（方差分析，p < 0.001），男性比例更高（p = 0.014），高血压（p = 0.001）和血脂异常（p = 0.006）更为常见。糖尿病患病率、既往心脏病史、入院时心力衰竭、前壁梗死、多支血管病变、肌酸激酶峰值或所开药物方面无差异，只是肥胖患者接受更多β受体阻滞剂治疗（p = 0.049）。正常BMI患者的住院死亡率为9.9%，超重患者为3.4%，肥胖患者为6.7%（p = 0.038）。30天死亡率分别为11%、4.4%和7.8%（p = 0.032），1年死亡率分别为12.9%、4.9%和9%（p = 0.023）。单因素分析显示，超重是唯一具有保护作用的BMI类别；然而，在对混杂变量进行多因素逻辑回归分析后，没有一个BMI类别能够独立预测预后。
与其他BMI类别相比，超重患者在接受直接血管成形术治疗ST段抬高型急性心肌梗死后预后更好，但这取决于其他潜在的混杂变量。
