Rivera-Caravaca José Miguel, Ruiz-Nodar Juan M, Tello-Montoliu Antonio, Esteve-Pastor María Asunción, Veliz-Martínez Andrea, Orenes-Piñero Esteban, Valdés Mariano, Pernias-Escrig Vicente, Sandin-Rollán Miriam, Vicente-Ibarra Nuria, Macías-Villanego Manuel J, Candela-Sánchez Elena, Lozano Teresa, Carrillo-Alemán Luna, Marín Francisco
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia: Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Spain.
2 Department of Cardiology, Hospital General Universitario de Alicante, Spain.
Eur J Cardiovasc Nurs. 2017 Dec;16(8):696-703. doi: 10.1177/1474515117710155. Epub 2017 May 16.
Being overweight increases the risk of cardiovascular diseases and mortality. However, among high-body-weight patients with established acute coronary syndrome (ACS) this evidence is not clear. In this scenario, a low body weight (LBW) has been proposed to confer higher prognostic risk and higher bleeding risk with new P2Y inhibitors.
We aimed to examine differences in mortality, catheterizations/revascularizations, antiplatelet therapy and ischemic/bleeding adverse events between ACS patients with LBW.
This is a multicenter registry involving 1576 consecutive ACS patients (ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina) from three tertiary institutions. Patients were divided into two groups: LBW (weight < 60 kg, n = 176) and non-LBW (weight ⩾ 60 kg, n = 1400). During 12 months follow-up, we recorded management (catheterizations/revascularizations), antiplatelet therapy, major adverse cardiovascular events (MACEs), bleeding events (BARC classification), and mortality.
Catheterizations (86.4% vs. 93.4%; p = 0.001) and revascularizations (64.8% vs. 76.1%; p = 0.001) were significantly lower in the LBW group. At discharge, prescription of new P2Y inhibitors was also lower in LBW patients (24.4% vs. 37.8%; p = 0.001). After 12-month follow-up, the incidence of MACE (HR 1.61 (95% CI 1.03-2.50]; p = 0.038) and mortality (HR 2.18 (95% CI 1.33-3.58); p = 0.002) was higher in LBW patients compared with non-LBW. In contrast, there were no significant differences for bleeding events.
LBW in ACS patients was associated with higher incidence of MACE and mortality. In this group of patients less catheterizations and coronary revascularizations were performed. Despite there being no differences in bleeding rates, new P2Y inhibitors were less prescribed in LBW patients.
超重会增加心血管疾病风险和死亡率。然而，在已确诊急性冠状动脉综合征（ACS）的高体重患者中，这一证据并不明确。在这种情况下，有人提出低体重（LBW）会使使用新型P2Y抑制剂时预后风险更高且出血风险更高。
我们旨在研究低体重ACS患者在死亡率、导管插入术/血运重建术、抗血小板治疗以及缺血/出血不良事件方面的差异。
这是一项多中心注册研究，纳入了来自三家三级医疗机构的1576例连续的ACS患者（ST段抬高型心肌梗死（STEMI）、非STEMI或不稳定型心绞痛）。患者被分为两组：低体重组（体重<60 kg，n = 176）和非低体重组（体重⩾60 kg，n = 1400）。在12个月的随访期间，我们记录了治疗情况（导管插入术/血运重建术）、抗血小板治疗、主要不良心血管事件（MACE）、出血事件（BARC分类）和死亡率。
低体重组的导管插入术（86.4%对93.4%；p = 0.001）和血运重建术（64.8%对76.1%；p = 0.001）显著更低。出院时，低体重患者使用新型P2Y抑制剂的处方率也更低（24.4%对37.8%；p = 0.001）。12个月随访后，低体重患者的MACE发生率（HR 1.61（95%CI 1.03 - 2.50]；p = 0.038）和死亡率（HR 2.18（95%CI 1.33 - 3.58）；p = 0.002）高于非低体重患者。相比之下，出血事件无显著差异。
ACS患者中的低体重与更高的MACE发生率和死亡率相关。该组患者接受的导管插入术和冠状动脉血运重建术较少。尽管出血率无差异，但低体重患者使用新型P2Y抑制剂的处方较少。
