Association between overweight and obesity with coronary artery bypass graft failure: an individual patient data analysis of clinical trials.

Autor:	An KR; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada., Sandner S; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Redfors B; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden., Alexander JH; Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, NC, USA., Alzghari T; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Caldonazo T; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Cancelli G; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Dell'Aquila M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Dimagli A; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Gibson CM; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA., Harik L; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Heise R; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA., Kulik A; Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital, Boca Raton, FL, USA., Lamy A; Department of Surgery, McMaster University, Hamilton, ON, Canada., Leith J; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Peper J; Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands., Perezgrovas-Olaria R; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Rossi CS; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Ruel M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada., Soletti GJ; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Ten Berg JM; Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands., Willemsen LM; Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands., Wojdyla DM; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Zhao Q; Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Zhu Y; Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Verma S; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada., Gaudino MFL; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2024 Jun 03; Vol. 65 (6).
DOI:	10.1093/ejcts/ezae221
Abstrakt:	Objectives: The association between obesity and graft failure after coronary artery bypass grafting has not been previously investigated. Methods: We pooled individual patient data from randomized clinical trials with systematic postoperative coronary imaging to evaluate the association between obesity and graft failure at the individual graft and patient levels. Penalized cubic regression splines and mixed-effects multivariable logistic regression models were performed. Results: Six trials comprising 3928 patients and 12 048 grafts were included. The median time to imaging was 1.03 (interquartile range 1.00-1.09) years. By body mass index (BMI) category, 800 (20.4%) patients were normal weight (BMI 18.5-24.9), 1668 (42.5%) were overweight (BMI 25-29.9), 983 (25.0%) were obesity class 1 (BMI 30-34.9), 344 (8.8%) were obesity class 2 (BMI 35-39.9) and 116 (2.9%) were obesity class 3 (BMI 40+). As a continuous variable, BMI was associated with reduced graft failure [adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.97-0.99)] at the individual graft level. Compared to normal weight patients, graft failure at the individual graft level was reduced in overweight [aOR 0.79 (95% CI 0.64-0.96)], obesity class 1 [aOR 0.81 (95% CI 0.64-1.01)] and obesity class 2 [aOR 0.61 (95% CI 0.45-0.83)] patients, but not different compared to obesity class 3 [aOR 0.94 (95% CI 0.62-1.42)] patients. Findings were similar, but did not reach significance, at the patient level. Conclusions: In a pooled individual patient data analysis of randomized clinical trials, BMI and obesity appear to be associated with reduced graft failure at 1 year after coronary artery bypass grafting. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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