The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2882-2892. doi: 10.1016/j.jcin.2020.09.024.
The aim of this study was to determine the prevalence and prognostic implications of elevated high-sensitivity C-reactive protein (hsCRP) in patients undergoing percutaneous coronary intervention (PCI) according to body mass index (BMI).
Whereas elevated hsCRP predicts adverse clinical outcome after PCI in the general population, the impact of BMI on its prognostic utility remains unclear.
Data from 14,140 patients who underwent PCI between January 2009 and June 2017 at a large tertiary care center were analyzed. Patients were divided into 4 BMI categories: normal (BMI 18.5 to <25 kg/m, n = 2,808), overweight (BMI 25 to <30 kg/m, n = 6,015), obese (BMI 30 to <35 kg/m, n = 3,490), and severely obese (BMI ≥35 kg/m, n = 1,827). Elevated hsCRP was defined as >3 mg/l. The primary endpoint of interest was the occurrence of major adverse cardiac events (MACE; defined as death, myocardial infarction, or target vessel revascularization) within 1 year after PCI.
Elevated hsCRP was present in 18.9%, 23.6%, 33.3%, and 47.7% of the normal, overweight, obese, and severely obese groups, respectively. MACE rates were consistently higher in patients with elevated hsCRP across all BMI categories (normal, 13.4% vs. 8.3%; overweight, 11.2% vs. 7.2%; obese, 10.6% vs. 7.5%; severely obese, 11.9% vs. 6.5%; p < 0.01 for all). After multivariate adjustment, hsCRP elevation remained significantly associated with MACE independent of BMI (hazard ratios: normal, 1.43 [95% confidence interval: 1.04 to 1.95]; overweight, 1.56 [95% confidence interval: 1.21 to 1.88]; obese, 1.40 [95% confidence interval: 1.06 to 1.84]; severely obese, 1.92 [95% confidence interval: 1.35 to 2.75]; p < 0.05 for all).
Among patients undergoing PCI, the prevalence of hsCRP elevation progressively increased with higher BMI. Measurement of hsCRP facilitates prognostic risk assessment for adverse outcome after PCI across a broad range of BMI.
本研究旨在根据体重指数（BMI）确定接受经皮冠状动脉介入治疗（PCI）的患者中升高的高敏 C 反应蛋白（hsCRP）的流行率和预后意义。
尽管 hsCRP 升高预示着普通人群 PCI 后的不良临床结局，但 BMI 对其预后实用性的影响仍不清楚。
对 2009 年 1 月至 2017 年 6 月在一家大型三级保健中心接受 PCI 的 14140 例患者的数据进行了分析。患者被分为 4 个 BMI 类别：正常（BMI 18.5 至＜25kg/m，n=2808）、超重（BMI 25 至＜30kg/m，n=6015）、肥胖（BMI 30 至＜35kg/m，n=3490）和重度肥胖（BMI≥35kg/m，n=1827）。hsCRP 升高定义为＞3mg/L。主要研究终点为 PCI 后 1 年内主要不良心脏事件（MACE；定义为死亡、心肌梗死或靶血管血运重建）的发生。
hsCRP 升高分别见于正常、超重、肥胖和重度肥胖组的 18.9%、23.6%、33.3%和 47.7%。hsCRP 升高的患者在所有 BMI 类别中 MACE 发生率均较高（正常：13.4% vs. 8.3%；超重：11.2% vs. 7.2%；肥胖：10.6% vs. 7.5%；重度肥胖：11.9% vs. 6.5%；p＜0.01）。多变量调整后，hsCRP 升高与 MACE 显著相关，独立于 BMI（危险比：正常：1.43[95%置信区间：1.04 至 1.95]；超重：1.56[95%置信区间：1.21 至 1.88]；肥胖：1.40[95%置信区间：1.06 至 1.84]；重度肥胖：1.92[95%置信区间：1.35 至 2.75]；p＜0.05）。
在接受 PCI 的患者中，hsCRP 升高的患病率随 BMI 升高而逐渐增加。hsCRP 的测量有助于在广泛的 BMI 范围内对 PCI 后不良结局的预后风险进行评估。
