体重指数对行介入治疗的急性ST段抬高型心肌梗死患者长期预后的影响  

Impact of Body Mass Index on Long-term Prognosis in Patients of Acute ST-segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention

作　　者：王欢欢[1] 赵雪燕[1] 高展[1] 乔树宾[1] 杨跃进[1] 高润霖[1] 徐波[1] 袁晋青[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2017年第4期348-352,共5页Chinese Circulation Journal

基　　金："十三五"国家科技支撑计划项目(2016YFC1301300);国家自然科学基金(81470486)

摘　　要：目的:探讨体重指数(BMI)对于行介入治疗的急性ST段抬高型心肌梗死(STEMI)患者长期预后的影响。方法:连续纳入了自2013-01至2013-12于阜外医院行介入治疗的STEMI患者1435例,根据BMI(kg/m^2)将患者分为正常体重组(18.5≤BMI<24.0,n=365)、超重组(24.0≤BMI<28.0,n=718)和肥胖组(BMI≥28.0,n=352),随访观察BMI对主要心脑血管不良事件的影响,并分析BMI对于全因死亡及心原性死亡是否有预测价值。结果:肥胖组的全因死亡率明显低于正常体重组(0.6%vs3.0%,P=0.027),而超重组则无统计学意义;而在出血、脑卒中、支架内血栓、血运重建、再次心肌梗死以及心原性死亡事件发生率3组间差异无统计学意义;多因素分析显示肥胖为全因死亡的独立预测因子(HR=0.201,95%CI:0.043~0.943,P=0.042);BMI并非为心原性死亡的独立预测因子。结论:对于STEMI行PCI的患者,肥胖患者的预后明显好于体重正常和超重的患者且为全因死亡独立预测因子,"肥胖悖论"在该人群中成立。Objective： To explore the impact of body mass index （BMI） on long-term prognosis in patients of acute ST-segment elevation myocardial infarction （STEMI） after percutaneous coronary intervention （PCI）. Methods： A total of 1435 consecutive STEMI patients received PCI in our hospital from 2013-01 to 2013-12 were enrolled. Based BMI （kg/m2）, the patients were divided into 3 groups： Normal weight group, the patients with 18.5≤BMI〈24.0, n=365, Overweight group, 24.0≤BMI〈28.0, n=718 and Obese group, BMI≥28.0, n=352. The impact of BMI on major adverse cardiovascular and cerebral events （MACCE） was observed; weather BMI had predictive value for all-cause mortality and cardiac death was analyzed. Results： All-cause mortality in Obese group was lower than Normal weight group （0.6% vs 3.0%）, P=0.027; while the incidences of bleeding, stroke, in-stent thrombosis, blood revascularization, re-myocardial infarction and cardiac death were similar among 3 groups. Multivariate analysis revealed that obesity was an independent predictor for all-cause death （HR=0.201, 95% CI 0.043-0.943, P=0.042）, BMI was not the independent predictor for cardiac death. Conclusion： For STEMI patients after PCI treatment, the individuals with obesity had the better prognosis than those with normal weight and overweight. Obesity was an independent predictor for all-cause death and ＂obesity paradox＂ was applicable in such population.

关 键 词：体重指数 心肌梗死 血管成形术 经腔 经皮冠状动脉 

分 类 号：R54[医药卫生—心血管疾病]