Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan.
PLoS One. 2024 Sep 19;19(9):e0309758. doi: 10.1371/journal.pone.0309758. eCollection 2024.
It is still unclear whether body mass index (BMI) affects bleeding and cardiovascular events in patients requiring oral anticoagulants (OAC) for atrial fibrillation (AF) and antiplatelet agents after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). The aim of this study was to evaluate the relationship between BMI and clinical events in patients who underwent PCI under OAC therapy for AF.
This was a multicenter, observational cohort study conducted at 15 institutions in Japan. AF patients who underwent PCI with drug-eluting stents for CAD were retrospectively and prospectively included. Patients were divided into the Group 1 (BMI <21.3 kg/m2) and the Group 2 (BMI ≥21.3 kg/m2) according to the first-quartile value of BMI. The primary endpoint was net adverse clinical events (NACE), a composite of major adverse cardiovascular events (MACE) and major bleeding events within one year after index PCI procedure.
In the 720 patients, 180 patients (25.0%) had BMI value <21.3 kg/m2. While the rates of NACE and MACE were significantly higher in the Group 1 than the counterpart (21.1% vs. 11.9%, p = 0.003 and 17.2% vs. 8.9%, p = 0.004), that of major bleeding did not differ significantly between the 2 groups (5.6% vs. 4.3%, p = 0.54). The cumulative rate of NACE and MACE was significantly higher in the Group 1 than the Group 2 (both log-rank p = 0.002), although that of major bleeding events was equivalent between the 2 groups (log-rank p = 0.41). In multivariable Cox regression analyses, while BMI value <21.3 kg/m2 was not associated with major bleeding events, that cut-off value was an independent predictor for increased NACE and MACE.
Among the patients undergoing PCI for CAD and requiring OAC for AF, BMI value was a useful indicator to predict major adverse clinical events.
目前尚不清楚体重指数（BMI）是否会影响因心房颤动（AF）需要口服抗凝剂（OAC）和因冠心病（CAD）需要经皮冠状动脉介入治疗（PCI）而接受 OAC 和抗血小板药物治疗的患者的出血和心血管事件。本研究的目的是评估在接受 AF 行 PCI 治疗的 OAC 治疗患者中 BMI 与临床事件之间的关系。
这是一项在日本 15 家机构进行的多中心、观察性队列研究。回顾性和前瞻性纳入了因 CAD 行药物洗脱支架 PCI 的 AF 患者。根据 BMI 的第一个四分位数值，患者被分为第 1 组（BMI<21.3kg/m2）和第 2 组（BMI≥21.3kg/m2）。主要终点是净不良临床事件（NACE），即指数 PCI 术后 1 年内主要不良心血管事件（MACE）和主要出血事件的复合终点。
在 720 例患者中，有 180 例（25.0%）BMI 值<21.3kg/m2。第 1 组的 NACE 和 MACE 发生率明显高于第 2 组（21.1% vs. 11.9%，p=0.003 和 17.2% vs. 8.9%，p=0.004），但两组间大出血发生率无显著差异（5.6% vs. 4.3%，p=0.54）。第 1 组的 NACE 和 MACE 累积发生率明显高于第 2 组（均为对数秩检验，p=0.002），尽管两组间大出血事件的发生率相当（对数秩检验，p=0.41）。多变量 Cox 回归分析显示，BMI 值<21.3kg/m2 与大出血事件无关，但该临界值是增加 NACE 和 MACE 的独立预测因子。
在因 CAD 行 PCI 治疗且因 AF 需要 OAC 的患者中，BMI 值是预测主要不良临床事件的有用指标。
