Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Ann Thorac Surg. 2011 Jan;91(1):42-7. doi: 10.1016/j.athoracsur.2010.08.047.
Numerous studies have documented an obesity paradox in which overweight and obese people with cardiovascular disease have a better prognosis compared with patients with normal body mass index (BMI). This study sought to quantify the effect of BMI on clinical outcomes after cardiac surgery and investigate the obesity paradox.
A concurrent cohort study of 2,440 consecutive patients undergoing cardiac surgery (coronary artery bypass grafting [CABG], valve, or CABG and valve surgery) from January 2004 to December 2008 was carried out. The patients were divided into three groups on the basis of BMI: normal weight (BMI 18.5 to 24.9; n=556; 23%), overweight (BMI 25.0 to 29.9; n=965; 39%), and obese (BMI≥30; n=919; 38%). Multivariable analyses and propensity score matching were used to compare the early and late clinical outcomes among the different BMI groups.
Overweight patients had a lower operative mortality (odds ratio, 0.4; 95% confidence interval, 0.2 to 0.9; p=0.031) compared with normal BMI patients. Obese patients had a comparable risk for operative mortality (odds ratio, 0.8; 95% confidence interval, 0.4 to 1.6; p=0.47) compared with normal-weight patients. Actuarial 5-year survival was better for the overweight (hazard ratio, 0.5; 95% confidence interval, 0.4 to 0.8; p=0.002) and comparable for the obese (hazard ratio, 0.9; 95% confidence interval, 0.5 to 1.4; p=0.49) groups compared with the normal-weight patients.
Overweight patients have better early hospital outcomes and improved survival after cardiac surgery compared with normal BMI patients, supporting the obesity paradox.
大量研究记录了超重和肥胖的心血管疾病患者的预后优于正常体重指数（BMI）患者的肥胖悖论。本研究旨在量化 BMI 对心脏手术后临床结局的影响，并探讨肥胖悖论。
对 2004 年 1 月至 2008 年 12 月期间接受心脏手术（冠状动脉旁路移植术 [CABG]、瓣膜或 CABG 和瓣膜手术）的 2440 例连续患者进行了同期队列研究。患者根据 BMI 分为三组：正常体重（BMI 18.5 至 24.9；n=556；23%）、超重（BMI 25.0 至 29.9；n=965；39%）和肥胖（BMI≥30；n=919；38%）。采用多变量分析和倾向评分匹配比较不同 BMI 组之间的早期和晚期临床结局。
与正常 BMI 患者相比，超重患者的手术死亡率较低（优势比，0.4；95%置信区间，0.2 至 0.9；p=0.031）。肥胖患者的手术死亡率风险与正常体重患者相当（优势比，0.8；95%置信区间，0.4 至 1.6；p=0.47）。与正常体重患者相比，超重患者的 5 年生存率更好（风险比，0.5；95%置信区间，0.4 至 0.8；p=0.002），肥胖患者的生存率相当（风险比，0.9；95%置信区间，0.5 至 1.4；p=0.49）。
与正常 BMI 患者相比，超重患者的早期住院结局更好，心脏手术后的生存率更高，支持肥胖悖论。
