Wang Tom Kai Ming, Ramanathan Tharumenthiran, Stewart Ralph, Gamble Greg, White Harvey
Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Victoria St West, Auckland 1142, New Zealand.
N Z Med J. 2013 Nov 22;126(1386):56-65.
Obesity has significant adverse effects on cardiovascular health. Conflicting results have been reported regarding relationships between body mass index (BMI) and outcomes after coronary artery bypass grafting (CABG). We compared outcomes of CABG patients by BMI categories.
Isolated CABG performed between July 2010-June 2012 at Auckland City Hospital were categorised into four groups of BMI ≤25 (normal), >25-30 (overweight), >30-35 (obese) and >35 kg/m² (morbidly obese) retrospectively for analyses.
The four groups had 181(22.4%), 320 (39.6%), 205 (25.3%) and 103 (12.7%) patients respectively. Increasing BMI was associated with younger age (p<0.001) and increasing creatinine clearance (p<0.001). Obesity was associated with a higher proportion of patients of Maori or Pacific ethnicity and patients with more hypertension. Morbid obesity was associated with female sex, higher mean New Zealand Deprivation Index, diabetes, longer operation time and sternal wound infection. Thirty-day mortality (p=0.702), composite morbidity (p=0.904) and survival (p=0.112) during 1.4 ± 0.6 years of follow-up were similar across BMI categories.
Obesity was common and was present in over a third of patients undergoing CABG with 13% of the entire cohort being morbidly obese. Mortality and morbidity rates did not differ across BMI categories. Obesity should not be considered a risk factor for adverse outcomes after CABG and should not be a contraindication for surgery.
肥胖对心血管健康有显著不良影响。关于体重指数（BMI）与冠状动脉旁路移植术（CABG）后结局之间的关系，已有相互矛盾的报道。我们按BMI类别比较了CABG患者的结局。
回顾性地将2010年7月至2012年6月在奥克兰市医院进行的单纯CABG手术患者分为四组，BMI≤25（正常）、>25 - 30（超重）、>30 - 35（肥胖）和>35 kg/m²（病态肥胖）进行分析。
四组患者分别有181例（22.4%）、320例（39.6%）、205例（25.3%）和103例（12.7%）。BMI增加与年龄较小（p<0.001）和肌酐清除率增加（p<0.001）相关。肥胖与毛利族或太平洋岛民种族患者及高血压患者比例较高相关。病态肥胖与女性、更高的平均新西兰贫困指数、糖尿病、手术时间延长和胸骨伤口感染相关。在1.4±0.6年的随访期间，不同BMI类别患者的30天死亡率（p = 0.702）、综合发病率（p = 0.904）和生存率（p = 0.112）相似。
肥胖很常见，超过三分之一的CABG手术患者存在肥胖，整个队列中有13%为病态肥胖。不同BMI类别患者的死亡率和发病率无差异。肥胖不应被视为CABG术后不良结局的危险因素，也不应作为手术禁忌证。
