The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction

被引:102
作者
Buettner, Heinz J.
Mueller, Christian
Gick, Michael
Ferenc, Marek
AlIgeier, Juergen
Comberg, Thomas
Werner, Klaus D.
Schindler, Christian
Neumann, Franz-Josef
机构
[1] Herz Zentrum, Intervent Cardiol, D-79189 Bad Krozingen, Germany
[2] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland
[3] Inst Social & Prevent Med, Basel, Switzerland
关键词
unstable angina; myocardial infarction; obesity; revascularization; BODY-MASS INDEX; PERCUTANEOUS CORONARY INTERVENTION; LONG-TERM OUTCOMES; UNSTABLE ANGINA; RISK-FACTORS; HEART; WEIGHT; ENDOCANNABINOIDS; ATHEROSCLEROSIS; ASSOCIATION;
D O I
10.1093/eurheartj/ehm220
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Obesity is associated with diabetes mellitus and advanced coronary artery disease (CAD). Once a non-ST-elevation acute coronary syndrome has occurred, the association between obesity and prognosis is poorly defined. This study was designed to assess the impact of obesity on outcome after unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) treated with early revascularization. Methods and results In a prospective cohort study in 1676 consecutive patients with UA/NSTEMI we examined the association between presence of obesity and all-cause mortality. All patients underwent coronary angiography and, if appropriate, early catheter-based revascularization. Patients were divided into four groups according to body mass index (BMI): normal, 18.5-24.9 (n = 551); overweight, 25-29.9 (n 824); obese, 30-34.9 (n = 244); and very obese, above 35 (n = 48). Obese and very obese patients were younger and had a higher incidence of hypertension, diabetes mellitus, elevated cardiac troponin T, and C-reactive protein levels. The angiographic extent of CAD was similar among the BMI groups. Median follow-up was 17 (interquartile range 6-31) months. Cumulative 3-year mortality rates were 9.9% for normal BMI, 7.7% for overweight, 3.6% for obese, and 0 (no death) for very obese (log-rank P = 0.043). Obese and very obese patients had less than half the long-term mortality when compared with normal BMI patients [hazard ratio (HR) 0.38, 95% confidence interval (CI) 0. 18-0.81, P = 0.012]. This result remained significant after adjustment for confounding prognostic factors including coronary status and left ventricular function (adjusted HR 0.27, 95% CI 0.08-0.92, P= 0.036). Conclusion Obesity is associated with improved outcome after UA/NSTEMI treated with early revascularization.
引用
收藏
页码:1694 / 1701
页数:8
相关论文
共 39 条
[1]   OBESITY, ATHEROSCLEROSIS, AND CORONARY-ARTERY DISEASE [J].
BARRETTCONNOR, EL .
ANNALS OF INTERNAL MEDICINE, 1985, 103 (06) :1010-1019
[2]   Body-mass index and mortality in a prospective cohort of US adults [J].
Calle, EE ;
Thun, MJ ;
Petrelli, JM ;
Rodriguez, C ;
Heath, CW .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (15) :1097-1105
[3]   Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. [J].
Cannon, CP ;
Weintraub, WS ;
Demopoulos, LA ;
Vicari, R ;
Frey, MJ ;
Lakkis, N ;
Neumann, FJ ;
Robertson, DH ;
DeLucca, PT ;
DiBattiste, PM ;
Gibson, CM ;
Braunwald, E .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (25) :1879-1887
[4]  
Corica F, 1999, MAGNESIUM RES, V12, P287
[5]   ADJUSTMENT FOR OBESITY IN STUDIES OF CARDIOVASCULAR-DISEASE [J].
CRIQUI, MH ;
KLAUBER, MR ;
BARRETTCONNOR, E ;
HOLDBROOK, MJ ;
SUAREZ, L ;
WINGARD, DL .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1982, 116 (04) :685-691
[6]   Leptin-regulated endocannabinoids are involved in maintaining food intake [J].
Di Marzo, V ;
Goparaju, SK ;
Wang, L ;
Liu, J ;
Bátkai, S ;
Járai, Z ;
Fezza, F ;
Miura, GI ;
Palmiter, RD ;
Sugiura, T ;
Kunos, G .
NATURE, 2001, 410 (6830) :822-825
[7]   Prevention conference VII -: Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke -: Executive summary [J].
Eckel, RH ;
York, DA ;
Rössner, S ;
Hubbard, V ;
Caterson, I ;
St Jeor, ST ;
Hayman, LL ;
Mullis, RM ;
Blair, SN .
CIRCULATION, 2004, 110 (18) :2968-2975
[8]   Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes [J].
Eisenstein, EL ;
McGuire, DK ;
Bhapkar, MV ;
Kristinsson, A ;
Hochman, JS ;
Kong, DF ;
Califf, RM ;
Van de Werf, F ;
Yancy, WS ;
Newby, LK .
AMERICAN JOURNAL OF MEDICINE, 2005, 118 (09) :981-990
[9]   Low-normal or excessive body mass index: Newly identified and powerful risk factors for death and other complications with percutaneous coronary intervention [J].
Ellis, SG ;
Elliott, J ;
Horrigan, M ;
Raymond, RE ;
Howell, G .
AMERICAN JOURNAL OF CARDIOLOGY, 1996, 78 (06) :642-646
[10]  
FerroLuzzi A, 1995, WHO TECH REP SER, V854, P1