He Pei-Yuan, Yang Yue-Jin, Qiao Shu-Bin, Xu Bo, Yao Min, Wu Yong-Jian, Wu Yuan, Yuan Jin-Qing, Chen Jue, Liu Hai-Bo, Dai Jun, Li Wei, Tang Yi-Da, Yang Jin-Gang, Gao Run-Lin
Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2015 Mar 5;128(5):638-43. doi: 10.4103/0366-6999.151662.
The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥ 75 years old remained unclear.
A total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤ 20.0 kg/m 2 ), normal weight (20.0-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ) and obese (≥ 30.0 kg/m 2 ). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders.
Totally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.
The BMI "obese paradox" was not found in patients ≥ 75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.
体重指数（BMI）对75岁及以上患者经皮冠状动脉介入治疗（PCI）后临床结局的影响尚不清楚。
共纳入1098例行PCI并植入支架的老年患者。根据BMI值将患者分为四组：体重过轻（≤20.0kg/m²）、正常体重（20.0-24.9kg/m²）、超重（25.0-29.9kg/m²）和肥胖（≥30.0kg/m²）。比较各组PCI后的主要临床结局。主要终点定义为院内主要不良心血管事件（MACE），包括死亡、心肌梗死（MI）和靶血管血运重建。次要终点定义为1年死亡率。进行逻辑回归分析以调整潜在混杂因素。
共1077例有可用BMI值的老年患者纳入分析。体重过轻、正常体重、超重和肥胖患者分别占总人群的5.6%、45.4%、41.5%和7.5%。体重过轻的患者更易发生ST段抬高型心肌梗死，且常伴有贫血或肾功能不全。同时，他们在PCI后达到心肌梗死溶栓3级血流的可能性较小，出院后接受β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的可能性也较小。体重过轻、正常体重、超重和肥胖患者的院内MACE发生率分别为１.7%、2.7%、3.8%和3.7%（P=0.68），1年死亡率分别为5.0%、3.9%、5.1%和3.7%（P=0.80），组间无显著差异。多因素回归分析显示，BMI值与75岁患者的院内MACE无关。
在75岁及以上患者中未发现BMI“肥胖悖论”。提示BMI可能不是老年患者不良心血管事件的敏感预测指标。
