Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry.

Autor: Numasawa Y; Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan., Kohsaka S; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan., Miyata H; University of Tokyo, Healthcare Quality Assessment, Tokyo, Japan., Kawamura A; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan., Noma S; Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan., Suzuki M; Department of Cardiology, National Hospital Organization, Saitama National Hospital, Saitama, Japan., Nakagawa S; Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan., Momiyama Y; Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan., Naito K; Department of Cardiology, Keiyu Hospital, Kanagawa, Japan., Fukuda K; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2015 Apr 14; Vol. 10 (4), pp. e0124399. Date of Electronic Publication: 2015 Apr 14 (Print Publication: 2015).
DOI: 10.1371/journal.pone.0124399
Abstrakt: Background: Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.
Methods: We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥ 18.5 and <25.0 (n=5,945); overweight, BMI ≥ 25.0 and <30.0 (n=3,100); and obese, BMI ≥ 30.0 (n=635).
Results: Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95% CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88-1.01; p=0.091).
Conclusions: Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.
Databáze: MEDLINE
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