Department of Cardiology, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea.
Department of Cardiology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
PLoS One. 2018 Dec 13;13(12):e0208817. doi: 10.1371/journal.pone.0208817. eCollection 2018.
A biphasic, U-shape relationship has been reported between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI). However, the relationship between waist circumference (WC) and the cardiovascular risk following PCI has not been reported.
A prospective cohort study was performed. A major adverse cardiac event (MACE) was defined as a composite of cardiac death (CD), nonfatal myocardial infarction (NFMI) and target vessel revascularization (TVR). Patients were evenly divided into 4 groups according to BMI (Q1BMI, Q2BMI, Q3BMI and Q4BMI) and WC (Q1WC, Q2WC, Q3WC and Q4WC).
A total of 1,421 patients were observed for 5 years. The risk of the composite events of CD and NFMI (CD/NFMI) was lower in the Q3WC and Q4WC groups than in the Q1WC group, whereas it was only marginally lower in the Q2BMI group than in the Q1BMI group (ANOVA, p = 0.062). The risk of MACE was highest in the Q1WC group and lowest in the Q3WC group; however, the risk of MACE did not differ among the 4 groups, according to BMI. Multivariate Cox-regression analyses showed that the risk of CD/NFMI gradually decreased with BMI (linear p = 0.030) and with WC (linear p = 0.015). The risks of TVR and MACEs that were driven by TVRs showed a distinguishing biphasic, U-shaped relationship with WC (nonlinear p = 0.009) but not with BMI (nonlinear p = 0.439). Landmark survival analysis showed that the incidences of CD and NFMI were higher in the lower BMI groups and lower WC groups than in the higher BMI groups and higher WC groups, respectively, until 1 year and did not differ afterward. In contrast, the incidence of MACE was highest in Q1WC and lowest in Q3WC (log-rank p = 0.003), whereas the incidence was not different among the groups according to BMI.
Both BMI and WC were associated with a lower risk of early episodes of CD and NFMI after PCI. In the late period after PCI, WC demonstrated a biphasic, U-shaped association between cardiovascular outcomes and adiposity, whereas BMI did not.
已有研究报告称，体质量指数（BMI）与经皮冠状动脉介入治疗（PCI）后的临床结局之间呈双相 U 型关系。然而，腰围（WC）与 PCI 后心血管风险之间的关系尚未得到报道。
进行了一项前瞻性队列研究。主要不良心脏事件（MACE）定义为心脏死亡（CD）、非致死性心肌梗死（NFMI）和靶血管血运重建（TVR）的复合事件。根据 BMI（Q1BMI、Q2BMI、Q3BMI 和 Q4BMI）和 WC（Q1WC、Q2WC、Q3WC 和 Q4WC）将患者平均分为 4 组。
共观察了 1421 例患者 5 年。与 Q1WC 组相比，Q3WC 和 Q4WC 组 CD/NFMI 的复合事件风险较低，而 Q2BMI 组与 Q1BMI 组相比，该风险仅略有降低（方差分析，p = 0.062）。MACE 风险在 Q1WC 组最高，在 Q3WC 组最低；然而，根据 BMI，4 组间 MACE 风险无差异。多变量 Cox 回归分析显示，CD/NFMI 的风险随 BMI（线性，p = 0.030）和 WC（线性，p = 0.015）逐渐降低。由 TVR 驱动的 TVR 和 MACE 风险与 WC 呈明显的双相 U 型关系（非线性，p = 0.009），但与 BMI 无关（非线性，p = 0.439）。里程碑生存分析显示，较低的 BMI 组和 WC 组的 CD 和 NFMI 发生率高于较高的 BMI 组和 WC 组，直到 1 年，之后无差异。相比之下，Q1WC 的 MACE 发生率最高，Q3WC 的发生率最低（对数秩检验，p = 0.003），而 BMI 组之间的发生率无差异。
BMI 和 WC 均与 PCI 后 CD 和 NFMI 的早期发作风险降低相关。在 PCI 后晚期，WC 与心血管结局和肥胖之间呈双相 U 型关系，而 BMI 则没有。
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