Haridasan Vellani, Rajesh K F, Sajeev C G, Rajesh G, Bastion Cicy, Vinayakumar D, Kadermuneer P, Mathew Dolly, George Biju, Krishnan M N
Assistant Professor, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
Senior Resident, Department of Cardiology, Government Medical College, Kozhikode, Kerala, India.
Indian Heart J. 2016 May-Jun;68(3):306-10. doi: 10.1016/j.ihj.2015.09.019. Epub 2016 Mar 2.
Obese patients with established coronary artery disease have reduced mortality compared to normal or low body mass index (BMI) patients. The reason for the relation is not yet clearly understood. We sought to evaluate the association of BMI and waist circumference (WC) at the time of presentation in patients with myocardial infarction (MI) with one-year adverse cardiac events.
In this prospective cohort study, we included consecutive patients with acute MI admitted to a tertiary care hospital during a period of one year. Upon admission, BMI and WC were measured. Patients were followed-up for a period of one year and the primary composite outcome of death or non-fatal MI was correlated with BMI and WC categories.
There were 703 patients (males 559 (79.5%)). Combined non-fatal MI and death at one year was 128 (18.2%). Incidence of primary outcome was 25.0% in low BMI group, 19.9% in normal BMI group, 13.1% in overweight group, 13.4% in class I obese, and 11.1% in class II obese groups. In univariate analysis, the inverse correlation was significant (p value=0.007). In one-year follow-up period, 12.8% in high and 20.8% in normal WC groups had primary outcome (p value=0.01). Both BMI and WC lost their predictive value in multivariate analysis.
Low BMI and normal WC were associated with a worse short-term outcome in patients with acute MI. Neither BMI nor WC independently predicted cardiac events or death after acute MI.
与正常或低体重指数（BMI）的患者相比，已确诊患有冠状动脉疾病的肥胖患者死亡率较低。这种关系的原因尚不清楚。我们试图评估心肌梗死（MI）患者就诊时BMI和腰围（WC）与一年不良心脏事件之间的关联。
在这项前瞻性队列研究中，我们纳入了一家三级护理医院在一年内连续收治的急性MI患者。入院时测量BMI和WC。对患者进行为期一年的随访，并将死亡或非致命性MI的主要复合结局与BMI和WC类别相关联。
共有703例患者（男性559例（79.5%））。一年时非致命性MI和死亡的联合发生率为128例（18.2%）。低BMI组的主要结局发生率为25.0%，正常BMI组为19.9%，超重组为13.1%，I类肥胖组为13.4%，II类肥胖组为11.1%。在单变量分析中，这种负相关具有显著性（p值=0.007）。在一年的随访期内，高WC组的主要结局发生率为12.8%，正常WC组为20.8%（p值=0.01）。在多变量分析中，BMI和WC均失去了预测价值。
低BMI和正常WC与急性MI患者较差的短期结局相关。BMI和WC均不能独立预测急性MI后的心脏事件或死亡。
