Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
Department of Medicine, Division of Cardiology, American University of the Caribbean Medical School, Coral Gables, Florida, USA.
Catheter Cardiovasc Interv. 2021 May 1;97(6):1186-1193. doi: 10.1002/ccd.28928. Epub 2020 Apr 22.
The effect of body mass index (BMI) on the procedural outcomes and health status (HS) change after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is largely unknown.
Thousand consecutive patients enrolled in a 12-center prospective CTO PCI study (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO]) were categorized into three groups by baseline BMI (obese ≥30, overweight 25-30, and normal 18.5-25), after excluding seven patients with BMI <18.5. Baseline and follow-up HS at 1 year were quantified using the Seattle Angina Questionnaire, Rose Dyspnea Score, and Personal Health Questionnaire-8 (PHQ-8). Hierarchical, multivariable logistic, and repeated measures linear regression models were used to assess procedural success, major adverse cardiovascular and cerebrovascular events (MACCE), and HS outcomes, as appropriate.
The obese and overweight were 47.6% and 37.4%, respectively. While procedure time and contrast dose were similar among the groups, total radiation dose (mGy) was higher with increased BMI (3,019 ± 2,027, 2,267 ± 1,714, 1,642 ± 1,223, p < .01). Procedural success rates, as well as MACCE rates, were similar among the three groups (obese 83.1%, overweight 79.8%, normal 81.9%, p = .47 and 5.1, 8.4, and 8.7%, p = .11). These rates remained similar after adjustment for baseline characteristics. The HS improvement from baseline to 12 months after adjustment was similar in obese and overweight patients compared to normal weight patients.
CTO PCI in obese and overweight patients can be performed with similar success and complication rates. Obese and overweight patients derive similar HS benefit from CTO PCI compared to normal weight patients.
体重指数（BMI）对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）后手术结果和健康状况（HS）变化的影响尚不清楚。
在一项 12 中心前瞻性 CTO PCI 研究（Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO]）中，连续纳入了 1000 例患者，根据基线 BMI（肥胖≥30、超重 25-30、正常 18.5-25）将患者分为三组，排除 BMI＜18.5 的 7 例患者。使用西雅图心绞痛问卷、罗丝呼吸困难评分和健康问卷-8（PHQ-8）评估基线和 1 年时的 HS。分层、多变量逻辑和重复测量线性回归模型用于评估手术成功率、主要不良心血管和脑血管事件（MACCE）和 HS 结果。
肥胖和超重患者分别占 47.6%和 37.4%。虽然三组之间的手术时间和造影剂剂量相似，但随着 BMI 的增加，总辐射剂量（mGy）更高（3019±2027、2267±1714、1642±1223，p＜0.01）。三组之间的手术成功率和 MACCE 发生率相似（肥胖 83.1%、超重 79.8%、正常 81.9%，p=0.47 和 5.1、8.4 和 8.7%，p=0.11）。调整基线特征后，这些比率仍然相似。调整后的 12 个月时与基线相比 HS 的改善在肥胖和超重患者中与正常体重患者相似。
肥胖和超重患者的 CTO PCI 可获得相似的成功率和并发症发生率。与正常体重患者相比，肥胖和超重患者从 CTO PCI 中获得相似的 HS 获益。
