Moscarella Elisabetta, Spitaleri Giosafat, Brugaletta Salvatore, Sentí Farrarons Sara, Pernigotti Alberto, Ortega-Paz Luis, Cequier Angel, Iñiguez Andrés, Serra Antonio, Jiménez-Quevedo Pilar, Mainar Vicente, Campo Gianluca, Tespili Maurizio, den Heijer Peter, Bethencourt Armando, Vazquez Nicolás, Valgimigli Marco, Serruys Patrick W, Sabaté Manel
University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Am J Cardiol. 2017 Nov 1;120(9):1460-1466. doi: 10.1016/j.amjcard.2017.07.040. Epub 2017 Jul 31.
Patients with high body mass index (BMI) seem to have better outcomes after percutaneous coronary intervention than normal-weight patients. However, contrasting results have been reported on the "obesity paradox" in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of our study was to investigate the impact of BMI on mortality in the population enrolled in the Evaluation of the Xience-V stent in Acute Myocardial INfArcTION (EXAMINATION) trial. The EXAMINATION trial randomized 1,498 patients with STEMI to a bare-metal stent or an everolimus-eluting stent. In this substudy patients were stratified into 3 groups according to BMI values: normal (BMI < 25 kg/m), overweight (BMI = 25 to 29.9 kg/m), and obese (BMI ≥ 30 kg/m). The coprimary end points were the all-cause and cardiac deaths among the groups at the 5-year follow-up. BMI was available in 1,421 patients, divided in 401 (28.2%) normal, 702 (49.4%) overweight, and 318 (22.4%) obese. Obese patients were younger (p = 0.012) compared with the other groups, but with a worse cardiovascular risk profile. They were more frequently female (p <0.001) and with a higher rate of obesity-related co-morbidity conditions such as diabetes mellitus (p = 0.005), arterial hypertension (p <0.001), and hyperlipidemia (p = 0.001) compared with the other groups. At the 5-year follow-up, all-cause and cardiac deaths were less frequent in obese patients than in the other groups (p = 0.003 and p = 0.030, respectively). After adjustment for confounding variables, BMI was an independent predictor of all-cause death (hazard ratio 0.765, 95% confidence interval 0.599 to 0.979, p = 0.033), but not of cardiac death, without any interaction with the stent type. In conclusion, in patients with STEMI who underwent primary PCI, the long-term all-cause death rate decreased as BMI increased, confirming the obesity paradox, irrespective of the stent type.
与体重正常的患者相比，高体重指数（BMI）的患者在经皮冠状动脉介入治疗后似乎有更好的预后。然而，关于ST段抬高型心肌梗死（STEMI）患者的“肥胖悖论”，已有相互矛盾的结果报道。我们研究的目的是调查BMI对急性心肌梗死Xience-V支架评估（EXAMINATION）试验入选人群死亡率的影响。EXAMINATION试验将1498例STEMI患者随机分为接受裸金属支架或依维莫司洗脱支架治疗。在这项子研究中，患者根据BMI值被分为3组：正常（BMI＜25kg/m²）、超重（BMI = 25至29.9kg/m²）和肥胖（BMI≥30kg/m²）。共同主要终点是5年随访时各组的全因死亡和心源性死亡。1421例患者有BMI数据：401例（28.2%）正常、702例（49.4%）超重、318例（22.4%）肥胖。与其他组相比，肥胖患者更年轻（p = 0.012），但心血管风险状况更差。与其他组相比，她们女性更常见（p＜0.001），且肥胖相关合并症发生率更高，如糖尿病（p = 0.005）、动脉高血压（p＜0.001）和高脂血症（p = 0.001）。在5年随访时，肥胖患者的全因死亡和心源性死亡比其他组更少见（分别为p = 0.003和p = 0.030）。在对混杂变量进行校正后，BMI是全因死亡的独立预测因素（风险比0.765，95%置信区间0.599至0.979，p = 0.033），但不是心源性死亡的独立预测因素，且与支架类型无任何相互作用。总之，在接受直接PCI的STEMI患者中，长期全因死亡率随BMI增加而降低，证实了肥胖悖论，与支架类型无关。
