Division of Cardiology, Montefiore Medical Center, Bronx, New York.
Department of Medicine, SSM Health, St Mary's Hospital, St. Louis, Missouri.
Am J Cardiol. 2019 Apr 15;123(8):1267-1272. doi: 10.1016/j.amjcard.2019.01.010. Epub 2019 Jan 24.
We reviewed 54,044 adult cases of cardiogenic shock (CS) accompanying acute coronary syndrome from the 2005 to 2014 Nationwide Inpatient Sample. We evaluated outcomes among patients who were nonobese, obese (body mass index 30.0 to 39.9 kg/m) and extremely-obese (body mass index ≥40 kg/m). A multivariate analysis was performed to assess their impact on in-hospital mortality. There were 3,602 (6.6%) and 1,610 (2.9%) admissions among patients who were obese and extremely-obese. Those obese and extremely-obese were younger compared with the nonobese (62.7 vs 61.2 vs 68.8 years, respectively; p <0.01) but had significantly greater comorbidity burden. CS patients who were not-obese were most likely to have an associated ST elevation myocardial infarction, compared with the obese and extremely-obese (67.7% vs 65.9% vs 60.7%; p <0.01). Compared to the nonobese, patients who were obese had higher rates of percutaneous coronary intervention (55.8% vs 51.5%; p <0.01) and coronary artery bypass grafting (24.0% vs 16.0%; p <0.01) whereas those extremely-obese had higher coronary artery bypass grafting rates (23.9% vs 16.0%; p <0.01) but similar percutaneous coronary intervention rates (51.1% vs 51.5%; p = 0.74). Short-term mechanical support use was lowest among the nonobese followed by the extremely-obese and obese. Adjusted analysis revealed that obesity predicted less (adjusted odd ratio 0.82, 95% confidence interval 0.76 to 0.90) and extreme-obesity predicted higher in-hospital mortality (adjusted odds ratio 1.17, 95% confidence interval 1.05 to 1.32) compared with the nonobese. In conclusion, obesity and extreme-obesity are associated with greater comorbidity burden among ACS related CS admissions. Obesity predicted less in-hospital mortality, whereas extreme obesity was associated with elevated in-hospital mortality.
我们回顾了 2005 年至 2014 年全国住院患者样本中 54044 例成人心源性休克（CS）合并急性冠状动脉综合征的病例。我们评估了非肥胖、肥胖（体重指数 30.0 至 39.9kg/m²）和极度肥胖（体重指数≥40kg/m²）患者的预后。采用多变量分析评估这些因素对住院死亡率的影响。肥胖和极度肥胖患者分别有 3602 例（6.6%）和 1610 例（2.9%）入院。与非肥胖患者相比，肥胖和极度肥胖患者年龄更小（分别为 62.7 岁、61.2 岁和 68.8 岁；p<0.01），但合并症负担明显更大。非肥胖 CS 患者最有可能合并 ST 段抬高型心肌梗死，而肥胖和极度肥胖患者则不然（分别为 67.7%、65.9%和 60.7%；p<0.01）。与非肥胖患者相比，肥胖患者经皮冠状动脉介入治疗（55.8% vs. 51.5%；p<0.01）和冠状动脉旁路移植术（24.0% vs. 16.0%；p<0.01）的比例更高，而极度肥胖患者的冠状动脉旁路移植术比例更高（23.9% vs. 16.0%；p<0.01），但经皮冠状动脉介入治疗的比例相似（51.1% vs. 51.5%；p=0.74）。非肥胖患者短期机械辅助使用率最低，其次是极度肥胖和肥胖患者。校正分析显示，肥胖（校正比值比 0.82，95%置信区间 0.76 至 0.90）和极度肥胖（校正比值比 1.17，95%置信区间 1.05 至 1.32）与非肥胖患者相比，预测的住院死亡率较低。总之，肥胖和极度肥胖与 ACS 相关 CS 入院患者的合并症负担增加有关。肥胖预测的住院死亡率较低，而极度肥胖与住院死亡率升高相关。
