Katagiri Yuki, Kasai Yutaro, Miyazaki Mamoru, Kuroda Ken, Hosoi Yuichiro, Ishikawa Kohei, Bota Hiroki, Ikeda Yuki, Sotomi Yohei, Matsutani Kenichi, Yamasaki Kazumasa, Tani Tomoyuki, Ueda Takashi, Yamazaki Seiji, Saito Shigeru
Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
JACC Asia. 2025 Jun;5(6):771-783. doi: 10.1016/j.jacasi.2025.03.003. Epub 2025 Mar 24.
The impact of obesity on mortality in patients with cardiogenic shock (CS) requiring microaxial flow pumps (mAFP) remains undetermined.
This study investigated the effect of body mass index (BMI) on mortality in CS patients treated with mAFP.
Data from 3,636 consecutive CS patients treated with Impella mAFP in the J-PVAD (Japanese Registry for Percutaneous Ventricular Assist Device) nationwide prospective registry in Japan between February 2020 and December 2022 were analyzed. Patients were stratified into 5 BMI categories: underweight (<18.5 kg/m), normal weight (18.5-22.9 kg/m), overweight (23.0-24.9 kg/m), obesity (25.0-29.9 kg/m), and severe obesity (≥30.0 kg/m). Multivariate Cox regression analysis assessed the relationship between BMI and 30-day mortality.
Crude 30-day mortality increased incrementally with higher BMI categories. Adjusted HRs for 30-day mortality (normal weight as reference) were 0.71 (95% CI [CI]: 0.56-0.90; P = 0.005) for underweight, 1.03 (95% CI: 0.88-1.21; P = 0.681) for overweight, 1.37 (95% CI: 1.19-1.57; P < 0.001) for obesity, and 2.00 (95% CI: 1.66-2.41; P < 0.001) for severe obesity. Patients in the underweight and severe obesity groups experienced a higher incidence of bleeding after percutaneous coronary intervention under mAFP, whereas hemolysis increased with higher BMI categories. Bleeding and hemolysis were associated with mortality only in patients who were underweight.
Higher BMI was associated with increased mortality in CS patients treated with mAFP. Although patients who were underweight demonstrated overall favorable survival outcomes, bleeding and hemolysis contributed to mortality in this group. Further research is needed to explore whether a BMI-based approach can improve clinical outcomes. (Japanese registry for Percutaneous Ventricular Assist Device; UMIN000033603).
肥胖对需要微型轴流泵（mAFP）的心源性休克（CS）患者死亡率的影响尚不确定。
本研究调查了体重指数（BMI）对接受mAFP治疗的CS患者死亡率的影响。
分析了2020年2月至2022年12月期间在日本全国性前瞻性注册研究J-PVAD（日本经皮心室辅助装置注册研究）中连续3636例接受Impella mAFP治疗的CS患者的数据。患者被分为5个BMI类别：体重过轻（<18.5kg/m²）、正常体重（18.5-22.9kg/m²）、超重（23.0-24.9kg/m²）、肥胖（25.0-29.9kg/m²）和重度肥胖（≥30.0kg/m²）。多变量Cox回归分析评估了BMI与30天死亡率之间的关系。
随着BMI类别的升高，30天粗死亡率逐渐增加。以正常体重为参照，体重过轻、超重、肥胖和重度肥胖患者30天死亡率的调整后HR分别为0.71（95%CI：0.56-0.90；P=0.005）、1.03（95%CI：0.88-1.21；P=0.681）、1.37（95%CI：1.19-1.57；P<0.001）和2.00（95%CI：1.66-2.41；P<0.001）。体重过轻和重度肥胖组患者在mAFP支持下经皮冠状动脉介入治疗后出血发生率较高，而溶血发生率随BMI类别升高而增加。出血和溶血仅在体重过轻的患者中与死亡率相关。
较高的BMI与接受mAFP治疗的CS患者死亡率增加相关。虽然体重过轻的患者总体生存结果良好，但出血和溶血导致了该组患者的死亡。需要进一步研究以探讨基于BMI的方法是否能改善临床结局。（日本经皮心室辅助装置注册研究；UMIN000033603）
