Zafrir Barak, Jaffe Ronen, Rubinshtein Ronen, Karkabi Basheer, Flugelman Moshe Y, Halon David A
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Am J Cardiol. 2018 Jan 1;121(1):113-119. doi: 10.1016/j.amjcard.2017.09.028. Epub 2017 Oct 13.
We examined 18,654 patients who underwent cardiac catheterization in a single center to clarify the association between catheterization indication, body mass index (BMI), and long-term survival over a mean follow-up of 81 months. Patients were grouped by indication for catheterization: (a) acute coronary syndromes (ACS), 7,426 patients; (b) coronary artery disease (CAD) evaluation in stable clinical presentation, 6,911 patients; and (c) primarily non-CAD cardiac evaluations, 4,317 patients. Compared with normal weight, overweight and obesity (but not morbid obesity) was associated with lower risk of long-term mortality. Underweight patients had the greatest risk of mortality. After multivariate adjustment, survival benefit of the overweight and obese was retained in the ACS group [hazard ratio 0.86, 95% confidence interval (0.77-0.96), p = 0.006 and 0.79, (0.68-0.91), p = 0.001, respectively] and in overweight patients in the stable presentation CAD group [0.83, (0.72-0.94), p = 0.005], whereas there was no survival benefit in any of the BMI categories in those catheterized primarily for non-CAD indications. Further analysis of matched cohorts showed similar patterns of survival benefit of the overweight/obese. In conclusion, among patients who underwent cardiac catheterization, an inverse association between BMI and long-term mortality was observed, with the lowest risk noted in the overweight and obese population; the obesity paradox was principally demonstrated in patients with ACS, and was eliminated after covariate adjustment in those catheterized primarily for non-CAD indications.
我们对在单一中心接受心导管插入术的18654例患者进行了研究，以阐明导管插入术指征、体重指数（BMI）与平均随访81个月的长期生存率之间的关联。患者按导管插入术指征分组：（a）急性冠脉综合征（ACS），7426例患者；（b）稳定临床表现的冠状动脉疾病（CAD）评估，6911例患者；（c）主要是非CAD心脏评估，4317例患者。与正常体重相比，超重和肥胖（但非病态肥胖）与较低的长期死亡风险相关。体重过轻的患者死亡风险最高。多变量调整后，超重和肥胖患者的生存获益在ACS组中得以保留[风险比0.86，95%置信区间（0.77 - 0.96），p = 0.006和0.79，（0.68 - 0.91），p = 0.001]，在稳定表现CAD组的超重患者中也得以保留[0.83，（0.72 - 0.94），p = 0.005]，而在主要因非CAD指征进行导管插入术的患者中，任何BMI类别均无生存获益。对匹配队列的进一步分析显示超重/肥胖患者有类似的生存获益模式。总之，在接受心导管插入术的患者中，观察到BMI与长期死亡率呈负相关，超重和肥胖人群的风险最低；肥胖悖论主要在ACS患者中表现出来，在主要因非CAD指征进行导管插入术的患者中经协变量调整后消失。
