Cemerlić-Adjić Nada, Pavlović Katica, Jevtić Marija, Velicki Radmila, Kostovski Sasa, Velicki Lazar
Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia.
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Vojnosanit Pregl. 2014 Jan;71(1):27-32. doi: 10.2298/vsp1401027c.
BACKGROUND/AIM: It had been suggested that elevated body mass index (BMI) is a beneficial and preventive factor when it comes to the outcome for patients undergoing coronary artery bypass grafting (CABG). At the same time, obesity is strongly associated with coronary artery disease development. The aim of this study was to determine the significance of the obesity paradox in patients referred for CABG and to examine if a relationship exists between obesity and early coronary surgery outcome.
This study comparised 791 patients who had undergone isolated CABG over one year period (year 2010). The average age of patients was 62.33 +/- 8.12 years and involved 568 (71.8%) male and 223 (28.2%) female patients, while the mean logistic EuroSCORE was 3.42%. The patients were categorized into three distinct groups based on their BMI: I - BMI < 24.9 kg/m2; II - BMI 25-30 kg/m2; III - BMI > 30 kg/m2. Regression analysis was conducted to determine whether BMI was an independent predictor of early mortality after CABG.
The majority of the cohort could be categorized as overweight (490/o) or obese (30%). There was no association between BMI and gender (p = 0.398). The overall early mortality was 2.15% (1.85% in the group I, 2.06% in the group II and 2.51% in the group III; p = 0.869). Univariate analysis showed that obesity cannot be regarded as an independent risk factor for early mortality following CABG (odds ratio 1.021, 95% confidence interval 0.910-1.145, p = 0.724). Duration of in-hospital period following the surgery was comparable within the BMI groups (p = 0.502).
Compared to non-obese patients, overweight and obese individuals have similar early mortality rate following CABG. This study can substantiate the presence of obesity paradox only in terms that elevated BMI patients have comparable outcome with non-obese. Further research is needed to delineate potential underlying mechanisms that set off obesity to protective factor for coronary surgery.
背景/目的：有人提出，较高的体重指数（BMI）对于接受冠状动脉搭桥术（CABG）的患者的预后而言是一个有益的预防因素。与此同时，肥胖与冠状动脉疾病的发展密切相关。本研究的目的是确定肥胖悖论在接受CABG治疗的患者中的意义，并探讨肥胖与早期冠状动脉手术预后之间是否存在关联。
本研究纳入了在一年期间（2010年）接受单纯CABG手术的791例患者。患者的平均年龄为62.33±8.12岁，其中男性568例（71.8%），女性223例（28.2%），平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）为3.42%。根据BMI将患者分为三个不同的组：I组 - BMI<24.9kg/m²；II组 - BMI为25 - 30kg/m²；III组 - BMI>30kg/m²。进行回归分析以确定BMI是否是CABG术后早期死亡率的独立预测因素。
该队列中的大多数患者可归类为超重（49%）或肥胖（30%）。BMI与性别之间无关联（p = 0.398）。总体早期死亡率为2.15%（I组为1.85%，II组为2.06%，III组为2.51%；p = 0.869）。单因素分析表明，肥胖不能被视为CABG术后早期死亡的独立危险因素（比值比1.021，95%置信区间0.910 - 1.145，p = 0.724）。BMI组之间术后住院时间相当（p = 0.502）。
与非肥胖患者相比，超重和肥胖个体在CABG术后的早期死亡率相似。本研究仅能在BMI升高的患者与非肥胖患者具有相似预后这一意义上证实肥胖悖论的存在。需要进一步研究以阐明使肥胖成为冠状动脉手术保护因素的潜在机制。
