Kunimura Ayako, Ishii Hideki, Uetani Tadayuki, Aoki Toshijirou, Harada Kazuhiro, Hirayama Kenshi, Negishi Yosuke, Shibata Yohei, Sumi Takuya, Kawashima Kazuhiro, Tatami Yosuke, Kawamiya Toshiki, Yamamoto Dai, Suzuki Susumu, Amano Tetsuya, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Cardiol. 2017 Mar 1;230:653-658. doi: 10.1016/j.ijcard.2017.01.008. Epub 2017 Jan 4.
An inverse association between obesity, as defined by body mass index (BMI) and prognosis has been reported in patients with cardiovascular disease ("obesity paradox"). The aim of this study was to investigate whether adding nutritional information to BMI provides better risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).
This study comprised 1004 patients undergoing elective PCI. We calculated each patient's controlling nutritional status (CONUT) score for nutritional screening at baseline. Patients were divided into 4 groups based on CONUT score (low, 0-1 [<75th percentile]; or high, ≥2 [≥75th percentile]) and BMI (normal, 18.5-24.9kg/m; or high, ≥25kg/m). The endpoint was major adverse cardiac events (MACE) defined as cardiac death and/or myocardial infarction.
Low CONUT score+normal BMI, low CONUT score+high BMI, high CONUT score+normal BMI, and high CONUT score+high BMI were determined in 374, 242, 275, and 113 patients, respectively. During a median follow-up of 1779 days, 73 events occurred. High CONUT score+normal BMI showed a 2.72-fold increase in the incidence of MACE (95% CI 1.46-5.08, p=0.002) compared with low CONUT score+normal BMI after adjusting for confounding factors. On the other hand, no significant difference in the incidence of MACE was observed in the other three groups.
The combination of CONUT score and BMI was a useful predictor of MACE in this population. Using BMI to assess the cardiovascular risk may be misleading unless the nutritional information is considered.
据报道，在心血管疾病患者中，以体重指数（BMI）定义的肥胖与预后呈负相关（“肥胖悖论”）。本研究的目的是调查在接受择期经皮冠状动脉介入治疗（PCI）的患者中，将营养信息添加到BMI中是否能提供更好的风险评估。
本研究纳入了1004例接受择期PCI的患者。我们在基线时计算了每位患者用于营养筛查的控制营养状况（CONUT）评分。根据CONUT评分（低，0-1[<第75百分位数]；或高，≥2[≥第75百分位数]）和BMI（正常，18.5-24.9kg/m；或高，≥25kg/m）将患者分为4组。终点为定义为心源性死亡和/或心肌梗死的主要不良心脏事件（MACE）。
低CONUT评分+正常BMI、低CONUT评分+高BMI、高CONUT评分+正常BMI和高CONUT评分+高BMI的患者分别有374例、242例、275例和113例。在中位随访1779天期间，发生了73起事件。在调整混杂因素后，高CONUT评分+正常BMI组的MACE发生率比低CONUT评分+正常BMI组增加了2.72倍（95%CI 1.46-5.08，p=0.002）。另一方面，其他三组的MACE发生率未观察到显著差异。
CONUT评分和BMI的组合是该人群中MACE的有用预测指标。除非考虑营养信息，否则使用BMI评估心血管风险可能会产生误导。
