Doshi Rajkumar, Rao Gaurav, Shlofmitz Evan, Donnelly Joseph, Meraj Perwaiz
Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York.
Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York.
Am J Cardiol. 2017 Nov 1;120(9):1648-1652. doi: 10.1016/j.amjcard.2017.07.065. Epub 2017 Jul 31.
Obesity is an independent risk factor for cardiovascular disease and mortality which may affect the outcomes of patients with peripheral arterial disease (PAD). However, the exact role of obesity in patients with PAD who underwent percutaneous revascularization is not well defined. We sought to analyze in-hospital outcomes and characteristics in obese patients who underwent percutaneous treatment for PAD. We identified study cohorts who underwent percutaneous treatment for PAD from 2012 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedures codes specific for PAD and endovascular treatment. Endovascular treatment included a drug-eluting stent, a bare metal stent, and an atherectomy or angioplasty in the lower extremities. Obesity was defined as a body mass index of >30 kg/m. Patients below 18 years of age were excluded. A total of 62,445 (weighted 312,225) patients were identified. The mean age was higher in the nonobese group (64.2 vs 69.0 years, p ≤0.001). No difference existed in the primary outcome, in-hospital mortality, with the propensity score matched (1:10) analysis. Renal failure and the composite of complications were increased in obese patients. Percutaneous treatment of PAD was associated with increased length of stay (7.7 vs 7.0 days, p ≤0.001) and median cost of hospitalization ($30,602 vs $28,692, p ≤0.001) in obese patients. In conclusion, obesity did not impact in-hospital mortality in patients who underwent peripheral percutaneous revascularization. Increased adverse events, however, were seen in the obese population. The increased cost associated with the hospitalization of obese patients may be attributed to longer length of stay and greater complication.
肥胖是心血管疾病和死亡的独立危险因素，可能影响外周动脉疾病（PAD）患者的治疗结果。然而，肥胖在接受经皮血管重建术的PAD患者中的确切作用尚不清楚。我们试图分析接受PAD经皮治疗的肥胖患者的住院结局和特征。我们使用国际疾病分类第九版临床修订本（ICD-9-CM）中特定于PAD和血管内治疗的诊断和手术编码，确定了2012年至2014年接受PAD经皮治疗的研究队列。血管内治疗包括药物洗脱支架、裸金属支架以及下肢的旋切术或血管成形术。肥胖定义为体重指数>30kg/m²。排除18岁以下的患者。共确定了62445例（加权后为312225例）患者。非肥胖组的平均年龄较高（64.2岁对69.0岁，p≤0.001）。倾向评分匹配（1:10）分析显示，主要结局即住院死亡率无差异。肥胖患者的肾衰竭和并发症综合发生率增加。肥胖患者接受PAD经皮治疗后住院时间延长（7.7天对7.0天，p≤0.001），住院费用中位数增加（30602美元对28692美元，p≤0.001）。总之，肥胖并未影响接受外周经皮血管重建术患者的住院死亡率。然而，肥胖人群中不良事件增加。肥胖患者住院费用增加可能归因于住院时间延长和并发症增多。
