Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Nutr Metab Cardiovasc Dis. 2020 May 7;30(5):730-737. doi: 10.1016/j.numecd.2020.01.001. Epub 2020 Jan 22.
Elderly patients are at increased risk of hemorrhagic and thrombotic complications after an acute coronary syndrome (ACS). Frailty, comorbidities and low body weight have emerged as conditioning the prognostic impact of dual antiplatelet therapy (DAPT). The aim of the present study was to investigate the prognostic impact of body mass index (BMI) on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study comparing low-dose (5 mg) prasugrel vs clopidogrel among elderly patients with ACS.
Our population is represented by 1408 patients enrolled in the Elderly-ACS 2 trial. BMI was calculated at admission. The primary endpoint of this analysis was cardiovascular (CV) mortality. Secondary endpoints were all-cause death, recurrent MI, Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding, and re-hospitalization for cardiovascular reasons or stent thrombosis within 12 months after index admission. Patients were grouped according to median values of BMI (<or ≥ 25.7 kg/m2). BMI was associated with hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate and hemoglobin (p < 0.001), and inversely with age (p = 0.005). Overweight patients displayed larger use of diuretics at admission (p = 0.03), aspirin pre-randomization (p = 0.01) and radial access (p = 0.04). At a median follow-up of 367 [337-378] days, BMI did not affect CV mortality in the overall population 4% vs 3.8%; adjusted HR [95%CI] = 2.3 [0.8-6.5], p = 0.12. Similar findings were observed for our secondary efficacy and safety endpoints. Results did not change when considering separately higher risk subsets of patients, (female gender, diabetics, ST-segment elevation myocardial infarction or the type of DAPT treatment allocation), with no significant interaction between these population characteristics and BMI.
Among elderly patients with ACS, BMI did not condition the survival or the risk of major cardiovascular and bleeding complications. The results were consistent across several patient risk categories.
急性冠状动脉综合征（ACS）后，老年患者出血和血栓并发症的风险增加。虚弱、合并症和低体重已成为双重抗血小板治疗（DAPT）预后影响的条件。本研究旨在探讨体质量指数（BMI）对 Elderly-ACS 2 试验中患者临床结局的预后影响，该试验是一项比较老年 ACS 患者低剂量（5mg）普拉格雷与氯吡格雷的随机、开放标签、盲终点研究。
我们的人群由 Elderly-ACS 2 试验中纳入的 1408 例患者组成。入院时计算 BMI。该分析的主要终点是心血管（CV）死亡率。次要终点是全因死亡、复发性 MI、出血学术研究联合会（BARC）2 型或 3 型出血、以及指数入院后 12 个月内因心血管原因或支架血栓再次住院。根据 BMI 的中位数（<或≥25.7kg/m2）将患者分组。BMI 与高血压、糖尿病、高胆固醇血症、估算肾小球滤过率和血红蛋白相关（p<0.001），与年龄呈负相关（p=0.005）。超重患者入院时利尿剂使用更大（p=0.03）、阿司匹林预先随机化（p=0.01）和桡动脉入路（p=0.04）。在中位数为 367[337-378]天的随访中，BMI 对全人群的 CV 死亡率没有影响（4% vs 3.8%；调整后的 HR[95%CI]为 2.3[0.8-6.5]，p=0.12）。我们的次要疗效和安全性终点也观察到了类似的结果。当分别考虑更高风险的患者亚组（女性、糖尿病患者、ST 段抬高型心肌梗死或 DAPT 治疗分配类型）时，结果没有改变，这些人群特征与 BMI 之间没有显著的相互作用。
在老年 ACS 患者中，BMI 不影响生存或主要心血管和出血并发症的风险。结果在几个患者风险类别中是一致的。
