摘要目的 了解体质指数(BMI)对接受血管重建治疗的冠心病心力衰竭(心衰)患者预后的影响.方法 药物洗脱支架对血运重建策略影响研究(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日对患者进行随访.本研究入选其中有体质指数(BMI)资料的慢性心衰患者1010例.将患者按BMI分为3组:BMI<24(正常组),BMI 24～27.9(超重组)和BMI≥28(肥胖组),比较不同组别之间的临床和预后情况.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 正常组295例,超重组495例,肥胖组220例.随访中位时间为542 d,超重和肥胖患者较年轻[(59.3±10.1)岁、(58.6±10.3)岁比(62.6.4±9.9)岁,P<0.01],高血压病史(61.2,66.8%比52.5%,P=0.017)和稳定型心绞痛(21.2%,23.7%比17.0%,P=0.005)比例高,甘油三酯[(1.90±1.05)mmol/L,(2.10±1.12)mmol/L比(1.48±0.92)mmol/L,P<0.01)]、空腹血糖[(6.07±2.09)mmol/L,(5.96±1.53)mmol/L比(5.67±1.92)mmol/L,P=0.021]和肌酐[(84.9±21.7)μmol/L,(90.2±30.9)μmol/L比(82.2±25.8)μmol/L]水平高(P均<0.05).与正常体重的患者相比,在调整了其他因素后,超重组的全因死亡风险(HR 0.769,95%CI 0.442～1.338)和MACCE(HR 0.998,95% CI 0.754～1.322)并未增加,而肥胖组全因死亡(HR 0.285,95%CI 0.104～0.777)和MACCE(HR 0.596,95% CI 0.401～0.885)风险降低.BMI对心性死亡无显著影响.结论 在进行血管重建的冠心病心衰患者中,尽管超重和肥胖者相对体重正常者有更多的危险因素,但是接受血管重建治疗后的预后不比体重正常者差.

abstractsObjectives To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. Methods The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1,2004 and September30 , 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI＜24; overweight group, BMI 24-27.9; obesity group, BMI≥ 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. Results 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59. 3 ± 10. 14 years, 58. 6 ± 10. 30 years vs 62. 6±9. 93 years, P＜0. 01) and had a significantly higher incidence of hypertension (61.2, 66. 8% vs 52. 5% , P=0. 017) , stable angina pectoris (21. 2% , 23. 7% vs 17. 0% ,P=0.05) and higher triglyceride[(1. 90±1.05) mmol/L,( 2. 10±1.12) mmol/L vs (1.48±0.92) mmol/L, P＜0.01)] , fasting blood glucoselevel [(6.07±2.09 )mmol/L, (5.96±1.53) mmol/L vs (5.67±1.92 )mmol/L, P=0.021) , blood creatinine (84. 9±21. 7) μmol/L, (90. 2±30. 9)μmol/L vs (82. 2±25. 8)μmol/L,P=0. 002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0. 285, 95% CI 0. 104-0. 777) and MACCE (0. 596, 95% CI 0.401-0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95% CI 0.442-1.338) and MACCE (0.998, 95% CI 0. 754 -1. 322) , there was hardly any significantly difference in cardiac mortality between three groups (P=0. 223). Conclusion There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.