Chatterjee Kshitij, Gupta Tanush, Goyal Abhinav, Kolte Dhaval, Khera Sahil, Shanbhag Anusha, Patel Kavisha, Villablanca Pedro, Agarwal Nayan, Aronow Wilbert S, Menegus Mark A, Fonarow Gregg C, Bhatt Deepak L, Garcia Mario J, Meena Nikhil K
Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Am J Cardiol. 2017 May 15;119(10):1548-1554. doi: 10.1016/j.amjcard.2017.02.030. Epub 2017 Mar 1.
Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p <0.001) and had lower risk-adjusted in-hospital mortality compared with nonobese patients (28.2% vs 36.5%; adjusted odds ratio 0.89, 95% CI 0.86 to 0.92; p <0.001). Similar findings were seen in subgroups of patients with cardiogenic shock complicating ST elevation or non-ST elevation MI. In conclusion, this large retrospective analysis of a nationwide cohort of patients with cardiogenic shock complicating AMI demonstrated that obese patients were younger, more likely to receive revascularization, and had modestly lower risk-adjusted in-hospital mortality compared with nonobese patients.
先前的多项研究表明，在急性心肌梗死（AMI）患者中，肥胖与更低的死亡率之间存在着与直觉相悖的关联；然而，肥胖与AMI并发心源性休克患者的院内死亡率之间的关联此前尚未得到研究。我们查询了2004年至2013年的全国住院患者样本数据库，以识别所有以AMI为主要诊断入院的18岁及以上患者。采用多变量回归模型，对人口统计学、医院特征和合并症进行调整，以研究肥胖患者与非肥胖患者中AMI并发心源性休克的发病率和院内死亡率的差异。在6,097,817例AMI患者中，290,894例（4.8%）发生了心源性休克。肥胖患者与非肥胖患者的心源性休克风险调整发病率无差异（调整优势比为1.00，95%置信区间为0.98至1.01；p = 0.46）。在AMI并发心源性休克的患者中，8.9%有肥胖的记录诊断。肥胖患者平均年轻6岁，大多数心血管合并症的患病率更高。肥胖患者更有可能接受血运重建（73.0%对63.4%，p<0.001），与非肥胖患者相比，其风险调整后的院内死亡率更低（28.2%对36.5%；调整优势比为0.89，95%置信区间为0.86至0.92；p<0.001）。在并发ST段抬高或非ST段抬高心肌梗死的心源性休克患者亚组中也观察到了类似的结果。总之，这项对全国范围内AMI并发心源性休克患者队列的大型回顾性分析表明，与非肥胖患者相比，肥胖患者更年轻，更有可能接受血运重建，且风险调整后的院内死亡率略低。
