Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Sahlgrenska University Hospital, Gothenburg, Sweden.
JACC Cardiovasc Interv. 2020 Apr 27;13(8):965-972. doi: 10.1016/j.jcin.2020.02.004.
The aim of this study was to examine the association between body mass index (BMI), infarct size (IS) and clinical outcomes.
The association between obesity, IS, and prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction is incompletely understood.
An individual patient-data pooled analysis was performed from 6 randomized trials of patients undergoing pPCI for ST-segment elevation myocardial infarction in which IS (percentage left ventricular mass) was assessed within 1 month (median 4 days) after randomization using either cardiac magnetic resonance (5 studies) or Tc sestamibi single-photon emission computed tomography (1 study). Patients were classified as normal weight (BMI <25 kg/m), overweight (25 kg/m ≤BMI <30 kg/m), or obese (BMI ≥30 kg/m). The multivariable models were adjusted for age, sex, hypertension, hyperlipidemia, current smoking, left main or left anterior descending coronary artery infarct, baseline TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 or 1, prior myocardial infarction, symptom-to-first device time, and study.
Among 2,238 patients undergoing pPCI, 644 (29%) were normal weight, 1,008 (45%) were overweight, and 586 (26%) were obese. BMI was not significantly associated with IS, microvascular obstruction, or left ventricular ejection fraction in adjusted or unadjusted analysis. BMI was also not associated with the 1-year composite risk for death or heart failure hospitalization (adjusted hazard ratio: 1.21 [95% confidence interval: 0.74 to 1.71] for overweight vs. normal [p = 0.59]; adjusted hazard ratio: 1.21 [95% confidence interval 0.74 to 1.97] for obese vs. normal [p = 0.45]) or for death or heart failure hospitalization separately. Results were consistent when BMI was modeled as a continuous variable.
In this individual patient-data pooled analysis of 2,238 patients undergoing pPCI for ST-segment elevation myocardial infarction, BMI was not associated with IS, microvascular obstruction, left ventricular ejection fraction, or 1-year rates of death or heart failure hospitalization.
本研究旨在探讨体重指数（BMI）、梗死面积（IS）与临床结局之间的关系。
人们对肥胖、ST 段抬高型心肌梗死患者行经皮冠状动脉介入治疗（pPCI）后的 IS 和预后之间的关系了解甚少。
对 6 项随机临床试验进行了个体患者数据汇总分析，这些临床试验均为 ST 段抬高型心肌梗死患者行 pPCI，其中 5 项研究使用心脏磁共振，1 项研究使用 Tc sestamibi 单光子发射计算机断层扫描，在随机分组后 1 个月内（中位数为 4 天）评估 IS（左心室质量百分比）。患者分为正常体重（BMI＜25kg/m²）、超重（25kg/m²≤BMI＜30kg/m²）或肥胖（BMI≥30kg/m²）。多变量模型调整了年龄、性别、高血压、高血脂、吸烟、左主干或左前降支梗死、基线 TIMI（心肌梗死溶栓）血流分级 0 或 1、既往心肌梗死、症状至首次设备时间和研究。
在 2238 例行 pPCI 的患者中，644 例（29%）为正常体重，1008 例（45%）为超重，586 例（26%）为肥胖。调整或未调整分析中，BMI 与 IS、微血管阻塞或左心室射血分数均无显著相关性。BMI 与 1 年全因死亡或心力衰竭住院的复合风险也无相关性（调整后的危险比：超重与正常相比为 1.21（95%置信区间：0.74 至 1.71），p=0.59；肥胖与正常相比为 1.21（95%置信区间：0.74 至 1.97），p=0.45），或分别死亡或心力衰竭住院。当 BMI 作为连续变量建模时，结果一致。
在这项对 2238 例行 pPCI 的 ST 段抬高型心肌梗死患者的个体患者数据汇总分析中，BMI 与 IS、微血管阻塞、左心室射血分数或 1 年死亡率或心力衰竭住院率无关。
