Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
Department of Anesthesia, University Hospital Basel, University of Basel, Basel, Switzerland.
Clin Res Cardiol. 2020 Sep;109(9):1140-1147. doi: 10.1007/s00392-020-01605-0. Epub 2020 Feb 5.
The impact of obesity on the incidence of perioperative myocardial infarction/injury (PMI) and mortality following non-cardiac surgery is not well understood.
We performed a prospective diagnostic study enrolling consecutive patients undergoing non-cardiac surgery, who were considered at increased cardiovascular risk. All patients were screened for PMI, defined as an absolute increase from preoperative to postoperative sensitive/high-sensitivity cardiac troponin T (hs-cTnT) concentrations. The body mass index (BMI) was classified according to the WHO classification (underweight< 18 kg/m, normal weight 18-24.9 kg/m, overweight 25-29.9 kg/m, obesity class I 30-34.9 kg/m, obesity class II 35-39.9 kg/m, obesity class III > 40 kg/m). The incidence of PMI and all-cause mortality at 365 days, both stratified according to BMI.
We enrolled 4277 patients who had undergone 5413 surgeries. The median BMI was 26 kg/m (interquartile range 23-30 kg/m). Incidence of PMI showed a non-linear relationship with BMI and ranged from 12% (95% CI 9-14%) in obesity class I to 19% (95% CI 17-42%) in the underweight group. This was confirmed in multivariable analysis with obesity class I. showing the lowest risk (adjusted OR 0.64; 95% CI 0.49-0.83) for developing PMI. Mortality at 365 days was lower in all obesity groups compared to patients with normal body weight (e.g., unadjusted OR 0.54 (95% CI 0.39-0.73) and adjusted OR 0.52 (95% CI 0.38-0.71) in obesity class I).
Obesity class I was associated with a lower incidence of PMI, and obesity in general was associated with a lower all-cause mortality at 365 days.
肥胖对非心脏手术后围手术期心肌梗死/损伤（PMI）和死亡率的影响尚不清楚。
我们进行了一项前瞻性诊断研究，纳入了接受非心脏手术的连续患者，这些患者被认为存在心血管风险增加。所有患者均接受了 PMI 的筛查，定义为术前至术后敏感/高敏肌钙蛋白 T（hs-cTnT）浓度的绝对升高。体重指数（BMI）根据世界卫生组织（WHO）分类进行分类（体重不足<18kg/m，正常体重 18-24.9kg/m，超重 25-29.9kg/m，肥胖 I 级 30-34.9kg/m，肥胖 II 级 35-39.9kg/m，肥胖 III 级>40kg/m）。根据 BMI 分层，分析 365 天内 PMI 和全因死亡率的发生率。
我们纳入了 4277 名接受了 5413 次手术的患者。中位 BMI 为 26kg/m（四分位距 23-30kg/m）。PMI 的发生率与 BMI 呈非线性关系，从肥胖 I 级的 12%（95%CI 9-14%）到体重不足组的 19%（95%CI 17-42%）不等。多变量分析证实肥胖 I 级的风险最低（调整后的 OR 0.64；95%CI 0.49-0.83）。与正常体重的患者相比，所有肥胖组在 365 天时的死亡率均较低（例如，肥胖 I 级的未调整 OR 0.54（95%CI 0.39-0.73）和调整 OR 0.52（95%CI 0.38-0.71））。
肥胖 I 级与 PMI 发生率较低相关，而肥胖总体上与 365 天全因死亡率较低相关。
