Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
Acad Emerg Med. 2013 Sep;20(9):904-10. doi: 10.1111/acem.12211.
Studies examining the relationship between obesity and acute coronary syndrome (ACS) have been limited to patients with confirmed diagnoses. The authors sought to determine the relationship between body mass index (BMI) and 30-day cardiovascular events in emergency department (ED) patients with potential ACS.
This was a secondary analysis of a prospective cohort study of patients who presented to the ED with potential ACS. Patients were stratified according to their BMI: underweight (BMI < 18.49 kg/m(2) ), normal weight (BMI = 18.5 to 24.99 kg/m(2) ), overweight (BMI = 25 to 29.99 kg/m(2) ), obese (BMI = 30 to 34.99 kg/m(2) ), and very obese (BMI > 35 kg/m(2) ). The primary outcome was acute myocardial infarction (AMI), death, or revascularization within 30 days of presentation. A logistic regression analysis was used to adjust for confounding variables and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) are presented for cardiac events and readmission outcomes.
Of the 3,946 patients included in this study, 73 (1.9%) were underweight, 911 (23%) were normal weight, 1,199 (30.4%) were overweight, 872 (22.1%) were obese, and 891 (22.6%) were very obese. Although increased levels of obesity were associated with a greater number of cardiac risk factors, there was no difference in 30-day cardiovascular events between those of normal weight and underweight (aOR = 1.1; 95% CI = 0.4 to 2.7), overweight (aOR = 1.0; 95% CI = 0.7 to 1.4), obese (aOR = 1.2; 95% CI = 0.8 to1.7), or very obese (aOR = 0.8; 95% CI = 0.5 to 1.3). Those who were underweight were more likely to be readmitted within 30 days (aOR = 1.9; 95% CI = 1.0 to 3.7), and those who were very obese were less likely to be readmitted within 30 days (aOR = 0.7; 95% CI = 0.5 to 0.9).
Among patients who present to the ED with potential ACS, BMI is not associated with higher risk of cardiovascular outcomes at 30 days.
研究肥胖与急性冠状动脉综合征（ACS）之间关系的研究仅限于确诊的患者。作者试图确定急诊部（ED）潜在 ACS 患者的 BMI 与 30 天心血管事件之间的关系。
这是一项对 ED 潜在 ACS 患者进行前瞻性队列研究的二次分析。根据 BMI 将患者分层：体重不足（BMI < 18.49 kg/m2）、正常体重（BMI = 18.5 至 24.99 kg/m2）、超重（BMI = 25 至 29.99 kg/m2）、肥胖（BMI = 30 至 34.99 kg/m2）和非常肥胖（BMI > 35 kg/m2）。主要结局是在出现症状后 30 天内发生急性心肌梗死（AMI）、死亡或血运重建。使用逻辑回归分析调整混杂变量，并报告心脏事件和再入院结果的调整比值比（aOR）和 95%置信区间（CI）。
在这项研究中，共有 3946 名患者，其中 73 名（1.9%）体重不足，911 名（23%）正常体重，1199 名（30.4%）超重，872 名（22.1%）肥胖，891 名（22.6%）非常肥胖。尽管肥胖程度的增加与更多的心脏危险因素相关，但正常体重和体重不足患者（aOR = 1.1；95%CI = 0.4 至 2.7）、超重患者（aOR = 1.0；95%CI = 0.7 至 1.4）、肥胖患者（aOR = 1.2；95%CI = 0.8 至 1.7）或非常肥胖患者（aOR = 0.8；95%CI = 0.5 至 1.3）之间 30 天心血管事件发生率无差异。体重不足的患者更有可能在 30 天内再次入院（aOR = 1.9；95%CI = 1.0 至 3.7），而非常肥胖的患者在 30 天内再次入院的可能性较低（aOR = 0.7；95%CI = 0.5 至 0.9）。
在因潜在 ACS 就诊于 ED 的患者中，BMI 与 30 天内心血管结局的风险增加无关。
