体重指数与进行血管重建的冠心病患者预后的关系

Impact of body mass index on Clinical Outcomes in Patients Undergoing Coronary Revascularization

目的了解体重指数(BMI)对接受血管重建治疗的冠心病患者预后的影响。方法DESIRE-plus为单中心回顾性注册研究,入选2004年7月1日至2005年9月30日在北京安贞医院接受血管重建治疗的3632例患者,2006年9月1日到11月30日对患者进行电话或门诊随访。本研究入选DESIRE-plus中有体重指数(BMI)资料的病例2895例。将这些患者按BMI分为四组,BMI<20组(低体重组),BMI20～24.9组(正常体重组),BMI25～29.9(超重组)和BMI≥30(肥胖组),比较不同组别之间的临床情况和预后情况。不良心脑血管事件(MACCE)包括全因死亡、非致死性心肌梗死、非致死性卒中和再次血管重建。结果低体重组92例,正常体重组1106例,超重组1454例,肥胖组243例。平均随访542d,与正常体重的患者相比,在调整了其他因素后,低体重组总死亡风险最高(HR2.711,95%CI1.159～6.341),超重组(HR0.926,95%CI0.541～1.588)和肥胖组(HR0.151,95%CI0.019～1.178)的总死亡风险并未增加。BMI对总MACCE及心血管病死亡无显著影响。结论在进行血运重建的冠心病患者中,尽管超重和肥胖者相对体重正常者有更多的危险因素,但是接受血运重建治疗后的预后不比体重正常者差,而低体重者的死亡风险增加。

Objective To determine the impact of body mass index （BMI） on clinical outcomes in patients underwent coronary revascularization. Methods The DESIRE-plus （ Drug-Eluting Stent Impact on Revascularization -plus） was a single-center registry study of coronary revascularization in our institution between 1 July 2004 and 30 September 2005. We analyzed patients with complete data of BMI from the DESIRE-plus trial, grouped by BMI （low BMI group： BMI 〈 20; normal BMI group： BMI 20 -24. 9; overweight group： BMI 25 -29.9 and obesity group： BMI ≥ 30 ）. The patients were followed up by telephone after discharge. Major adverse cerebral-cardiovascular events （MACCE） including death, neo- myocardial infarction, stroke, re-revascularization were recorded and the hazard risk for each group were then evaluated. Results A total of 2 895 patients were included in the study （92 in the low BMI group; 1 106 in normal BMI group; 1 454 in overweight group and 243 obesity group）. Median follow-up duration was 542 days. Patients with a low BMI had an increased hazard risk （HR） for total mortality （ 2.711,95% CI 1. 159 -6. 341） compared with those for patients with a normal BMI, overweight （ HR 0. 926, 95% CI 0. 541 - 1. 588） and obese patients （ HR 0. 151,95% CIO. 019 - 1. 178） who showed no increased risk for total mortality. There was hardly any significant difference in MACCE or cardiac mortality among the four groups. Conclusion There are more risk factors in coronary heart disease patients complicated with obesity or overweight, but the prognosis after revascularization of them is not inferior to the normal weight coronary heart disease patients. However, patients with a low BMI showed the worst outcome.