日本真实世界多中心注册研究中体重指数对接受经皮冠状动脉介入治疗患者院内并发症的影响。
Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry.
作者信息
Numasawa Yohei, Kohsaka Shun, Miyata Hiroaki, Kawamura Akio, Noma Shigetaka, Suzuki Masahiro, Nakagawa Susumu, Momiyama Yukihiko, Naito Kotaro, Fukuda Keiichi
机构信息
Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
出版信息
PLoS One. 2015 Apr 14;10(4):e0124399. doi: 10.1371/journal.pone.0124399. eCollection 2015.
BACKGROUND
Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.
METHODS
We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥ 18.5 and <25.0 (n=5,945); overweight, BMI ≥ 25.0 and <30.0 (n=3,100); and obese, BMI ≥ 30.0 (n=635).
RESULTS
Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95% CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88-1.01; p=0.091).
CONCLUSIONS
Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.
背景
肥胖与晚期心血管疾病相关。然而，一些研究报道了经皮冠状动脉介入治疗（PCI）后的“肥胖悖论”。体重指数（BMI）与PCI术后临床结局之间的关系尚未得到充分研究，尤其是在亚洲人群中。
方法
我们研究了2008年9月至2013年4月期间在15家参与JCD - KICS注册研究的日本医院接受PCI的10142例患者。根据BMI将患者分为四组：体重过轻，BMI<18.5（n = 462）；正常，BMI≥18.5且<25.0（n = 5945）；超重，BMI≥25.0且<30.0（n = 3100）；肥胖，BMI≥30.0（n = 635）。
结果
BMI较高的患者比BMI较低的患者明显更年轻（p<0.001），且患有高血压（p<0.001）、高脂血症（p<0.001）、糖尿病（p<0.001）和当前吸烟（p<0.001）等冠状动脉危险因素的发生率更高。重要的是，体重过轻组患者的院内结局最差，包括总体并发症（体重过轻、正常、超重和肥胖组：20.4%、11.5%、8.4%和10.2%，p<0.001）、院内死亡率（5.8%、2.1%、1.2%和2.7%，p<0.001）、心源性休克（3.5%、2.0%、1.5%和1.6%，p = 0.018）、出血并发症（10.0%、4.5%、2.6%和2.8%，p<0.001）以及接受输血（7.6%、2.7%、1.6%和1.7%，p<0.001）。经多因素逻辑回归分析调整后，BMI与出血并发症呈负相关（比值比，0.95；95%置信区间，0.92 - 0.98；p = 0.002）。在无心脏性休克患者的亚组多因素分析中，BMI与总体并发症（OR，0.98；95%CI，0.95 - 0.99；p = 0.033）和出血并发症（OR，0.95；95%CI，0.91 - 0.98；p = 0.006）呈负相关。此外，存在BMI与院内死亡率中度相关的趋势（OR，0.94；95%CI，0.88 - 1.01；p = 0.091）。
结论
在PCI期间及之后，体重过轻的患者而非肥胖患者发生院内并发症的风险更大，尤其是出血并发症。
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