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Hochhausen N, Mechelinck M, Billig S, Rossaint R, Kork F. Association between chronic obstructive pulmonary disease and in-hospital mortality after percutaneous coronary intervention: a retrospective cohort study in Germany. Sci Rep 2024; 14:6044. [PMID: 38472246 DOI: 10.1038/s41598-024-56255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases worldwide. However, the impact of COPD on outcome after percutaneous coronary intervention (PCI) remains unclear. In this retrospective cohort study, we analyzed the data of hospitalized patients undergoing PCI in Germany between 2015 and 2019. We compared in-hospital mortality, hospital length of stay and peri-interventional ventilation time (VT) in patients with and without COPD, including different COPD severity grades, COPD with exacerbation (COPDe) and infection (COPDi). We analyzed the data of 3,464,369 cases undergoing PCI. A total of 291,707 patients (8.4%) suffered from COPD. Patients suffering from COPD died more often (2.4% vs. 2.0%; p < 0.001), stayed longer hospitalized (5 days (2-10) vs. 3 days (1-6); p < 0.001), were more frequent (7.2% vs. 3.2%) and longer ventilated (26 h (7-88) vs. 23 h (5-92); p < 0.001). Surprisingly, COPD was associated with a 0.78-fold odds of in-hospital mortality and with reduced VT (- 1.94 h, 95% CI, - 4.34 to 0.43). Mild to severe COPD was associated with a lower risk of in-hospital mortality and reduced VT, whereas very severe COPD, COPDe and COPDi showed a higher risk of in-hospital mortality. We found a paradoxical association between mild to severe COPD and in-hospital mortality, whereas very severe COPD, COPDe and COPDi were associated with higher in-hospital mortality. Further investigations should illuminate, whether comorbidities affect these associations.
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Affiliation(s)
- Nadine Hochhausen
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Mare Mechelinck
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sebastian Billig
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix Kork
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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2
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Kim BG, Hong SJ, Kim BK, Lee YJ, Lee SJ, Ahn CM, Shin DH, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Association Between Body Mass Index and Clinical Outcomes According to Diabetes in Patients Who Underwent Percutaneous Coronary Intervention. Korean Circ J 2023; 53:843-854. [PMID: 37973975 PMCID: PMC10751187 DOI: 10.4070/kcj.2023.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We evaluated the effect of diabetes on the relationship between body mass index (BMI) and clinical outcomes in patients following percutaneous coronary intervention (PCI) with drug-eluting stent implantation. METHODS A total of 6,688 patients who underwent PCI were selected from five different registries led by Korean Multicenter Angioplasty Team. They were categorized according to their BMI into the following groups: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight to obese (≥25.0 kg/m²). Major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, nonfatal myocardial infarction, stroke, and target-vessel revascularization, were compared according to the BMI categories (underweight, normal and overweight to obese group) and diabetic status. All subjects completed 1-year follow-up. RESULTS Among the 6,688 patients, 2,561 (38%) had diabetes. The underweight group compared to normal weight group had higher 1-year MACCE rate in both non-diabetic (adjusted hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.04-4.84; p=0.039) and diabetic patients (adjusted HR, 2.86; 95% CI, 1.61-5.07; p<0.001). The overweight to obese group had a lower MACCE rate than the normal weight group in diabetic patients (adjusted HR, 0.67 [0.49-0.93]) but not in non-diabetic patients (adjusted HR, 1.06 [0.77-1.46]), with a significant interaction (p-interaction=0.025). CONCLUSIONS Between the underweight and normal weight groups, the association between the BMI and clinical outcomes was consistent regardless of the presence of diabetes. However, better outcomes in overweight to obese over normal weight were observed only in diabetic patients. These results suggest that the association between BMI and clinical outcomes may differ according to the diabetic status.
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Affiliation(s)
- Byung Gyu Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Yong-Joon Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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3
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Altintas S, van Workum S, Kok M, Joosen IA, Versteylen MO, Nelemans PJ, Wildberger JE, Crijns HJ, Das M, Kietselaer BL. BMI is not independently associated with coronary artery calcification in a large single‐center CT cohort. Obes Sci Pract 2022; 9:172-178. [PMID: 37034565 PMCID: PMC10073817 DOI: 10.1002/osp4.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Obesity is associated with cardiovascular disease (CVD) and CVD mortality. However, previous reports showed a paradoxical protective effect in patients with known CVD referred as "obesity paradox". Therefore, the aim of the present study was to investigate the association of body mass index (BMI) with coronary artery calcification (CAC) in a large outpatient cardiac CT cohort. Methods 4.079 patients who underwent cardiac CT between December 2007-May 2014 were analyzed. BMI and clinical risk factors (current smoking, diabetes mellitus type 2, family history, systolic blood pressure, lipid spectrum) were assessed. Missing values were imputed using multiple imputation. CAC extent was categorized as absent (0), mild (>0-100), moderate (>100-400) and severe (>400). Results Multivariable multinomial logistic regression analysis, including all risk factors as independent variables, showed no association between BMI and CAC. Using absence of calcification as reference category, the odds ratios per unit increase in BMI were 1.01 for mild; 1.02 for moderate; and 1.00 for severe CAC (p-values ≥0.103). Conclusions No statistically significant association was observed between BMI and CAC after adjustment for other risk factors.
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Affiliation(s)
- Sibel Altintas
- Department of Cardiology Maastricht University Medical Center (MUMC+) Nijmegen the Netherlands
| | - Samanta van Workum
- Department of Cardiology Canisius Wilhelmina hospital Nijmegen the Netherlands
| | - Madeleine Kok
- Department of Radiology University Medical Center Utrecht (UMCU) Nijmegen the Netherlands
| | - Ivo A.P.G. Joosen
- Department of Cardiology Canisius Wilhelmina hospital Nijmegen the Netherlands
| | | | - Patricia J. Nelemans
- Department of Epidemiology CAPHRI School for Public Health and Primary Care University Faculty of Health Medicine and Life Sciences Maastricht the Netherlands
| | | | - Harry J.G.M. Crijns
- Department of Cardiology Maastricht University Medical Center (MUMC+) Nijmegen the Netherlands
| | - Marco Das
- Department of Radiology Helios Klinikum Duisburg Germany
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4
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Morishita T, Uzui H, Mitsuke Y, Tada H. Relationship of body mass index to clinical outcomes after percutaneous coronary intervention. Eur J Clin Invest 2022; 52:e13789. [PMID: 35397173 DOI: 10.1111/eci.13789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elevated body mass index (BMI) demonstrates lower all-cause and cardiovascular mortalities compared with normal-weight or lean patients in chronic diseases. This study investigated relationships between BMI and clinical outcomes following percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients, together with the sex-specific impacts of BMI on mortality. METHODS We reviewed 1104 CAD patients who underwent PCI between 2006 and 2015. Patients were divided by BMI into three groups: lean, <18.5 kg/m2 ; normal, 18.5-24.9 kg/m2 ; and overweight/obese, ≥25 kg/m2 . The primary endpoint was all-cause mortality, and the secondary endpoint was 3-point major adverse cardiovascular events (MACE). RESULTS Kaplan-Meier survival analysis demonstrated risks of all-cause death, and 3-point MACE were higher in lean patients compared with normal-weight and overweight/obese subjects (log-rank p < .001). Cox proportional hazard modelling showed overweight/obese was significantly associated with all-cause death (hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.48-0.95; p = .03), and lean was significantly associated with 3-point MACE (HR 2.02, 95% CI 1.15-3.53; p = .01). Cox proportional hazard analysis with restricted cubic spline showed non-linear associations between BMI and both all-cause mortality and 3-point MACE (p for effect = .002 and = .003, respectively). No significant interaction was evident between sex and BMI for all-cause mortality (p for interaction = .104) or 3-point MACE (p for interaction =0.122). CONCLUSIONS Lean category was associated with adverse outcomes among CAD patients. An obesity paradox regarding the independent association of elevated BMI with reduced mortality after PCI is evident in both males and females.
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Affiliation(s)
- Tetsuji Morishita
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department Cardiovascular Medicine, National Hospital Organization Awara Hospital, Fukui, Japan.,Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasuhiko Mitsuke
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department Cardiovascular Medicine, National Hospital Organization Awara Hospital, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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5
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Mei X, Hu S, Mi L, Zhou Y, Chen T. Body mass index and all-cause mortality in patients with percutaneous coronary intervention: A dose-response meta-analysis of obesity paradox. Obes Rev 2021; 22:e13107. [PMID: 32686338 DOI: 10.1111/obr.13107] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
The association between body mass index (BMI) and mortality of patients with percutaneous coronary intervention (PCI) is still controversial. We hope to explore whether the 'obesity paradox' really exists through this dose-response meta-analysis. PubMed, Embase and Cochrane databases were systematically searched for eligible studies up to April 2020. The random-effects restricted cubic spline models were used to evaluate the potential non-linear relationship between BMI and all-cause mortality of patients undergoing PCI. Fifteen studies were identified and included total 138 592 participants. The pooled hazard ratio of all-cause mortality was 0.60 (95% confidence interval: 0.45-0.82) when compared the highest category (mean = 33.32 kg m-2 ) of BMI with the lowest category (mean = 18.89 kg m-2 ). A non-linear U-shaped dose-response curve between BMI and the risk of all-cause mortality was found, with higher mortality rate at BMI lower than 27 kg m-2 and higher than 32 kg m-2 . The 'obesity paradox' does exist after PCI. The association between BMI and the risk of all-cause mortality for patients undergoing PCI is U shaped, with a nadir of risk at a BMI of 27 to 32 kg m-2 and the highest risk at patients with underweight. The relationship between other prognostic indicators and BMI is worthy of further research.
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Affiliation(s)
- Xiaofei Mei
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengda Hu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijie Mi
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yafeng Zhou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tan Chen
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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6
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Itoh H, Kaneko H, Kiriyama H, Kamon T, Fujiu K, Morita K, Yotsumoto H, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Reverse J-shaped relationship between body mass index and in-hospital mortality of patients hospitalized for heart failure in Japan. Heart Vessels 2020; 36:383-392. [PMID: 32980921 DOI: 10.1007/s00380-020-01699-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023]
Abstract
Several lines of evidence demonstrated body mass index (BMI) to be inversely associated with outcomes of patients with HF, so-called obesity paradox. However, the relationship between BMI and outcomes of patients with HF in Japan has been poorly understood. This study sought to explore the relationship between BMI and in-hospital mortality of patients hospitalized for heart failure (HF) in Japan and whether BMI at hospital admission could be used for the risk stratification of hospitalized HF patients. We studied 407,722 patients hospitalized for HF between January 2010 and March 2018, using the Diagnosis Procedure Combination database, a national inpatient database in Japan. Patients were categorized into four groups: underweight (BMI < 18.5 kg/m2), 66,342 patients (16.3%); normal (18.5-24.9 kg/m2), 240,801 patients (59.1%); pre-obesity (25.0-29.9 kg/m2), 76,954 patients (18.9%); and obesity (≥ 30.0 kg/m2), 23,625 patients (5.8%). Pre-obese and obese patients were younger and more likely to be male. Advanced HF symptoms were more common among underweight patients. Multivariable logistic regression analysis fitted with generalized estimating equation showed that, compared with normal weight patients underweight patients had higher in-hospital mortality (odds ratio 1.50, 95% confidence interval 1.45-1.55), whereas pre-obese patients (odds ratio 0.80, 95% confidence interval 0.77-0.83) and obese patients (odds ratio 0.90, 95% confidence interval 0.84-0.97) had lower in-hospital mortality. Restricted cubic spline showed a reverse J-shaped relationship between BMI and in-hospital mortality with the bottoms of splines around BMI 26 kg/m2. In conclusion, underweight patients had higher, and pre-obese and obese patients had lower in-hospital mortality compared to patients with normal weight patients. Furthermore, restricted cubic spline indicated a reverse J-shaped relationship between BMI and in-hospital mortality. Our findings are informative for the risk stratification of patients hospitalized for HF according to BMI.
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Affiliation(s)
- Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Haruki Yotsumoto
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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7
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Al'Aref SJ, Singh G, van Rosendael AR, Kolli KK, Ma X, Maliakal G, Pandey M, Lee BC, Wang J, Xu Z, Zhang Y, Min JK, Wong SC, Minutello RM. Determinants of In-Hospital Mortality After Percutaneous Coronary Intervention: A Machine Learning Approach. J Am Heart Assoc 2020; 8:e011160. [PMID: 30834806 PMCID: PMC6474922 DOI: 10.1161/jaha.118.011160] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The ability to accurately predict the occurrence of in‐hospital death after percutaneous coronary intervention is important for clinical decision‐making. We sought to utilize the New York Percutaneous Coronary Intervention Reporting System in order to elucidate the determinants of in‐hospital mortality in patients undergoing percutaneous coronary intervention across New York State. Methods and Results We examined 479 804 patients undergoing percutaneous coronary intervention between 2004 and 2012, utilizing traditional and advanced machine learning algorithms to determine the most significant predictors of in‐hospital mortality. The entire data were randomly split into a training (80%) and a testing set (20%). Tuned hyperparameters were used to generate a trained model while the performance of the model was independently evaluated on the testing set after plotting a receiver‐operator characteristic curve and using the output measure of the area under the curve (AUC) and the associated 95% CIs. Mean age was 65.2±11.9 years and 68.5% were women. There were 2549 in‐hospital deaths within the patient population. A boosted ensemble algorithm (AdaBoost) had optimal discrimination with AUC of 0.927 (95% CI 0.923–0.929) compared with AUC of 0.913 for XGBoost (95% CI 0.906–0.919, P=0.02), AUC of 0.892 for Random Forest (95% CI 0.889–0.896, P<0.01), and AUC of 0.908 for logistic regression (95% CI 0.907–0.910, P<0.01). The 2 most significant predictors were age and ejection fraction. Conclusions A big data approach that utilizes advanced machine learning algorithms identifies new associations among risk factors and provides high accuracy for the prediction of in‐hospital mortality in patients undergoing percutaneous coronary intervention. See Editorial by Garratt and Schneider
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Affiliation(s)
- Subhi J Al'Aref
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Gurpreet Singh
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | | | - Kranthi K Kolli
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Xiaoyue Ma
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Gabriel Maliakal
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Mohit Pandey
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Bejamin C Lee
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Jing Wang
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Zhuoran Xu
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Yiye Zhang
- 2 Division of Health Informatics Weill Cornell Graduate School of Medical Sciences New York NY
| | - James K Min
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - S Chiu Wong
- 3 Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
| | - Robert M Minutello
- 3 Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
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8
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Brostow DP, Warsavage TJ, Abbate LM, Starosta AJ, Brenner LA, Plomondon ME, Valle JA. Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program. Clin Obes 2019; 9:e12300. [PMID: 30793500 DOI: 10.1111/cob.12300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/22/2022]
Abstract
Mental illness and obesity are highly prevalent in patients with coronary disease and are frequently comorbid. While mental illness is an established risk factor for major adverse cardiac and cerebrovascular events (MACCEs), prior studies suggest improved outcomes in people with obesity. It is unknown if obesity and mental illness interact to affect cardiac outcomes or if they independently influence MACCE. We identified 55 091 patients undergoing percutaneous coronary intervention (PCI) between 2009 and 2014, using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program. Cox methods were used to assess the risk of MACCE by weight status and psychiatric diagnosis, and assessed for interaction. Compared to normal weight status, higher weight was associated with reduced MACCE events after PCI (mean follow-up of 2 years) for both stable angina and acute coronary syndromes (ACSs; reduction of >13% in stable angina, >17% in ACS; P < 0.01 for both after adjustment). Having a non-substance abuse mental illness diagnosis increased risk of MACCE compared to patients without mental illness in stable angina over 17%; P < 0.05, but not in ACS. When analysed for interaction, obesity and mental illness did not significantly impact MACCE over their independent influences. These results suggest that mental illness along with weight status have significant impact on MACCE, post-PCI. Clinicians should be aware of patients' mental health status as a significant cardiovascular risk factor after PCI, independent of weight status.
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Affiliation(s)
- Diana P Brostow
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Theodore J Warsavage
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Rocky Mountain VA Medical Center, Aurora, CO, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa A Brenner
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Rocky Mountain VA Medical Center, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
- Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Mary E Plomondon
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Javier A Valle
- Division of Cardiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
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9
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Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data. Atherosclerosis 2018; 277:155-162. [DOI: 10.1016/j.atherosclerosis.2018.08.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/29/2018] [Accepted: 08/30/2018] [Indexed: 11/21/2022]
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10
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Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention. PLoS One 2018; 13:e0203352. [PMID: 30212493 PMCID: PMC6136739 DOI: 10.1371/journal.pone.0203352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/20/2018] [Indexed: 12/27/2022] Open
Abstract
Background Limiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus. Objective We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). Methods We evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI. Results A V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42–2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22–2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05–1.10]; P < 0.001). Conclusions A V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.
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Simoni L, Shirka E, Hasimi E, Kabili S, Goda A. Differences Among Body Mass Index (BMI) Groups in Patients Undergoing First Elective Percutaneous Coronary Intervention. Med Arch 2018; 69:396-9. [PMID: 26843733 PMCID: PMC4720460 DOI: 10.5455/medarh.2015.69.396-399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND PURPOSE Body Mass Index (BMI) is known to be an independent risk factor for hypertension, type 2 diabetes mellitus, dyslipidemia and various cardiovascular diseases. Our aim was to investigate the differences among BMI groups in patients undergoing first elective PCI. METHODS 781 consecutive patients who underwent their first-time elective PCI from September 2011 to December 2013 in the Department of Cardiology were enrolled in the study. The patients with BMI < 18.5 kg/m(2) or > 50 kg/m(2) and those who had previously undergone revascularization were excluded from the study. Patients were categorized according to their BMI groups. BMI 18.5 - 24.9 kg/m(2) normal group, 25 - 29.9 kg/m(2) overweight group and > 30 kg/m(2) obese group. We studied the demographic, angiographic, and interventional differences between BMI groups. RESULTS Compared with normal weight individuals, those obese were younger (61.9 ±10.34 vs. 58.41 ± 8.01 p = 0.0006), had higher prevalence of diabetes mellitus (46.4% vs. 26.6% p = 0.0001), dyslipidemia (77.5% vs. 65.4% p=0.0134) and hypertension (1.3% vs. 81.3% p=0.0067). There was a greater use of calcium channel blockers (CCBs) and Angiotensin Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs) in obese individuals but it was not statistically significant. Obese individuals were associated with higher risk anatomy (3-Vessel CAD or LM) compared to normal individuals but not statistically significant (18.8% vs. 14.2% p=0.25). Obese patients were associated with a higher length of stents/person used (36.7 ± 22.02 vs. 31.7 ± 17.48 p=0.016) and also a larger diameter of stents/person used (3.14 ± 0.4 vs. 2.98 ± 0.33 p=0.0001) compared to normal individuals. CONCLUSIONS Patients with a higher BMI are younger and have diabetes mellitus, hypertension and dyslipidemia more frequently. Patients with a higher BMI have a higher length and larger diameter of stents/person used, probably related to a more extensive coronary artery disease.
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Affiliation(s)
- Leonard Simoni
- Cardiology Department, University Hospital Center "Mother Theresa" Tirana, Albania
| | - Ervina Shirka
- Cardiology Service, European Hospital, Tirana, Albania
| | - Endri Hasimi
- Cardiology Department, University Hospital Center "Mother Theresa" Tirana, Albania
| | - Suerta Kabili
- Cardiology Department, University Hospital Center "Mother Theresa" Tirana, Albania
| | - Artan Goda
- Cardiology Department, University Hospital Center "Mother Theresa" Tirana, Albania
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12
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Endo H, Dohi T, Shitara J, Wada H, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Kasai T, Okazaki S, Isoda K, Miyauchi K, Daida H. Impact of body mass index on long-term outcomes in Japanese patients following percutaneous coronary intervention: The Juntendo PCI Registry. J Cardiol 2018; 72:208-214. [PMID: 29550145 DOI: 10.1016/j.jjcc.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/20/2018] [Accepted: 02/02/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The prognostic long-term impact of body mass index (BMI) on East Asian patients with coronary artery disease remains unclear. METHODS An observational retrospective cohort study was carried out involving 3571 patients who had undergone percutaneous coronary intervention (PCI) from 2000 to 2013. Patients were divided into the following five groups according to baseline BMI: Group 1 (underweight 1, BMI ≤20.0kg/m2); Group 2 (underweight 2, BMI=20.1-22.5kg/m2); Group 3 (normal weight, BMI=22.6-25.0kg/m2); Group 4 (overweight 1, BMI=25.1-27.5kg/m2); and Group 5 (overweight 2, BMI ≥27.6kg/m2). We then evaluated the association between BMI and both all-cause and cardiac death after PCI. RESULTS The ratio of patients in the five groups was as follows: Group 1, 9.2%; Group 2, 21.6%; Group 3, 34.1%; Group 4, 21.1%; and Group 5, 14.5%. A decrease in age was observed from underweight to overweight, as was an increased prevalence of hypertension, diabetes mellitus, dyslipidemia, and smoking. The median follow-up period was 6.3 years (interquartile range, 3.2-9.6 years). In total, 473 deaths (frequency, 13.2%) were identified, including 183 (5.1%) cardiac deaths during follow-up. In unadjusted Cox proportional hazard analysis, using normal weight as the reference, underweight, but not overweight, was associated with a greater risk of both all-cause and cardiac death. In an adjusted model, Group 1 had the highest risk for all-cause death (hazard ratio, 1.58; 95% confidence interval, 1.19-2.10; p=0.0019); however, no significant differences were found for the risk of all-cause and cardiac death between normal weight and overweight patients. CONCLUSION The results of the present long-term follow-up study do not support the so-called "obesity paradox," but rather, suggest that underweight Japanese patients are at greater risk for all-cause mortality following PCI.
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Affiliation(s)
- Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hirokazu Konishi
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Ma WQ, Sun XJ, Wang Y, Han XQ, Zhu Y, Liu NF. Does body mass index truly affect mortality and cardiovascular outcomes in patients after coronary revascularization with percutaneous coronary intervention or coronary artery bypass graft? A systematic review and network meta-analysis. Obes Rev 2018; 19:1236-1247. [PMID: 30035367 DOI: 10.1111/obr.12713] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/02/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity, a comorbid medical condition, is usually observed in patients with established coronary artery disease. Paradoxically, patients with a higher body mass index (BMI) usually have better clinical outcomes after coronary revascularization. METHODS We searched five online databases through December 2017. We identified studies reporting the rate of all-cause mortality or cardiovascular-related outcomes among patients after coronary revascularization with percutaneous coronary intervention or coronary artery bypass graft based on various BMI categories. Network meta-analysis was performed using Bayesian methods. RESULTS Sixty-five records involving 865,774 participants were included in our study. A U-shaped association was observed across BMI categories for all-cause mortality. Using normal weight as the reference, all-cause mortality was increased for (relative risk [RR]: 2.4; 95% credibility interval [CrI]: 2.1-2.7) patients with underweight, whereas it was lowered in patients with overweight, obese, and severely obese. This association remained significant in many subgroups. We also observed that the risk of major adverse cardiovascular events (MACE) was lowest among patients with overweight. Furthermore, patients with underweight were associated with greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5), cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR: 2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7) compared with normal weight patients; no significant association was observed among individuals with higher BMI. CONCLUSIONS The 'obesity paradox' does exist in patients after coronary revascularization, especially for patients with post-percutaneous coronary intervention. All-cause mortality in patients with high BMI is significantly lower compared with patients with normal weight. Furthermore, patients with underweight experience higher rates of cardiovascular outcomes compared with patients with normal weight.
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Affiliation(s)
- W-Q Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - X-J Sun
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - Y Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - X-Q Han
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - Y Zhu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
| | - N-F Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
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Zhang JC, Matelski J, Gandhi R, Jackson T, Urbach D, Cram P. Can Patient Selection Explain the Obesity Paradox in Orthopaedic Hip Surgery? An Analysis of the ACS-NSQIP Registry. Clin Orthop Relat Res 2018; 476:964-973. [PMID: 29480892 PMCID: PMC5916618 DOI: 10.1007/s11999.0000000000000218] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 01/22/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The "obesity paradox" is a phenomenon described in prior research in which patients who are obese have been shown to have lower postoperative mortality and morbidity compared with normal-weight individuals. The paradox is that clinical experience suggests that obesity is a risk factor for difficult wound healing and adverse cardiovascular outcomes. We suspect that the obesity paradox may reflect selection bias in which only the healthiest patients who are obese are offered surgery, whereas nonobese surgical patients are comprised of both healthy and unhealthy individuals. We questioned whether the obesity paradox (decreased mortality for patients who are obese) would be present in nonurgent hip surgery in which patients can be carefully selected for surgery but absent in urgent hip surgery where patient selection is minimized. QUESTIONS/PURPOSES (1) What is the association between obesity and postoperative mortality in urgent and nonurgent hip surgery? (2) How is obesity associated with individual postoperative complications in urgent and nonurgent hip surgery? (3) How is underweight status associated with postoperative mortality and complications in urgent and nonurgent hip surgery? METHODS We used 2011 to 2014 data from the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) to identify all adults who underwent nonurgent hip surgery (n = 63,148) and urgent hip surgery (n = 29,047). We used logistic regression models, controlling for covariants including age, sex, anesthesia risk, and comorbidities, to examine the relationship between body mass _index (BMI) category (classified as underweight < 18.5 kg/m, normal 18.5-24.9 kg/m, overweight 25-29.9 kg/m, obese 30-39.9 kg/m, and morbidly obese > 40 kg/m) and adverse outcomes including 30-day mortality and surgical complications including wound complications and cardiovascular events. RESULTS For patients undergoing nonurgent hip surgery, regression models demonstrate that patients who are morbidly obese were less likely to die within 30 days after surgery (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.57; p = 0.038) compared with patients with normal BMI, consistent with the obesity paradox. For patients undergoing urgent hip surgery, patients who are morbidly obese had similar odds of death within 30 days compared with patients with normal BMI (OR, 1.18; 95% CI, 0.76-1.76; p = 0.54). Patients who are morbidly obese had higher odds of wound complications in both nonurgent (OR, 4.93; 95% CI, 3.68-6.65; p < 0.001) and urgent cohorts (OR, 4.85; 95% CI, 3.27-7.01; p < 0.001) compared with normal-weight patients. Underweight patients were more likely to die within 30 days in both nonurgent (OR, 3.79; 95% CI, 1.10-9.97; p = 0.015) and urgent cohorts (OR, 1.47; 95% CI, 1.23-1.75; p < 0.001) compared with normal-weight patients. CONCLUSIONS Patients who are morbidly obese appear to have a reduced risk of death in 30 days after nonurgent hip surgery, but not for urgent hip surgery. Our results suggest that the obesity paradox may be an artifact of selection bias introduced by careful selection of the healthiest patients who are obese for elective hip surgery. Surgeons should continue to consider obesity a risk factor for postoperative mortality and complications such as wound infections for both urgent and nonurgent surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Joyce C Zhang
- J. C. Zhang, Department of Medicine, University of Toronto, Toronto, Ontario, Canada J. Matelski, Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada R. Gandhi, Division of Orthopaedic Surgery and Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada T. Jackson, Department of Surgery, University Heath Network, University of Toronto, Toronto, Ontario, Canada R. Gandhi, T. Jackson, D. Urbach, Department of Surgery, University of Toronto, Toronto, Ontario, Canada D. Urbach, Department of Surgery, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada P. Cram, Division of General Internal Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
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15
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Azhari Z, Ismail MD, Zuhdi ASM, Md Sari N, Zainal Abidin I, Wan Ahmad WA. Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. BMJ Open 2017; 7:e017794. [PMID: 29127228 PMCID: PMC5695449 DOI: 10.1136/bmjopen-2017-017794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) in a multiethnic South East Asian population. SETTING Fifteen participating cardiology centres contributed to the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. PARTICIPANTS 28 742 patients from the NCVD-PCI registry who had their first PCI between January 2007 and December 2014 were included. Those without their BMI recorded or BMI <11 kg/m2 or >70 kg/m2 were excluded. MAIN OUTCOME MEASURES In-hospital death, major adverse cardiovascular events (MACEs), vascular complications between different BMI groups were examined. Multivariable-adjusted HRs for 1-year mortality after PCI among the BMI groups were also calculated. RESULTS The patients were divided into four groups; underweight (BMI <18.5 kg/m2), normal BMI (BMI 18.5 to <23 kg/m2), overweight (BMI 23 to <27.5 kg/m2) and obese (BMI ≥27.5 kg/m2). Comparison of their baseline characteristics showed that the obese group was younger, had lower prevalence of smoking but higher prevalence of diabetes, hypertension and dyslipidemia. There was no difference found in terms of in-hospital death, MACE and vascular complications after PCI. Multivariable Cox proportional hazard regression analysis showed that compared with normal BMI group the underweight group had a non-significant difference (HR 1.02, p=0.952), while the overweight group had significantly lower risk of 1-year mortality (HR 0.71, p=0.005). The obese group also showed lower HR but this was non-significant (HR 0.78, p=0.056). CONCLUSIONS Using Asian-specific BMI cut-off points, the overweight group in our study population was independently associated with lower risk of 1-year mortality after PCI compared with the normal BMI group.
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Affiliation(s)
- Zaid Azhari
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Syadi Mahmood Zuhdi
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Norashikin Md Sari
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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16
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Patel N, Elsaid O, Shenoy A, Sharma A, McFarlane SI. Obesity paradox in patients undergoing coronary intervention: A review. World J Cardiol 2017; 9:731-736. [PMID: 29081905 PMCID: PMC5633536 DOI: 10.4330/wjc.v9.i9.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
There is strong relationship between obesity and cardiovascular disease including coronary artery disease (CAD). However, the literature has shown better outcomes in higher obese patients who undergo percutaneous cardiovascular interventions for CAD, a phenomenon known as the obesity paradox (OX). In this review, we performed extensive search for OX in patients undergoing percutaneous coronary intervention. We also discussed possible mechanism OX and disparities in different race and sex.
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Affiliation(s)
- Nirav Patel
- Department of Cardiology, Hartford Hospital, Hartford, CT 06001, United States
| | - Ossama Elsaid
- Department of Cardiology, Hartford Hospital, Hartford, CT 06001, United States
| | - Abhishek Shenoy
- University of Virginia Health System, SUNY Downstate, Brooklyn, NY 11203, United States
| | - Abhishek Sharma
- Department of Cardiology, SUNY Downstate, Brooklyn, NY 11203, United States
| | - Samy I McFarlane
- Department of Medicine, Division of Endocrinology, SUNY Downstate, Brooklyn, NY 11203, United States
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17
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Tanaka A, Yoshida H, Kawaguchi A, Oyama JI, Kotooka N, Toyoda S, Inoue T, Natsuaki M, Node K. N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study. Sci Rep 2017; 7:5810. [PMID: 28724951 PMCID: PMC5517578 DOI: 10.1038/s41598-017-06090-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/07/2017] [Indexed: 12/16/2022] Open
Abstract
Few data on clinical characteristics associated with N-terminal pro-brain natriuretic peptide (NT-proBNP) or the clinical value of measuring NT-proBNP in the working population are available. The aim of the present study was to investigate the levels of NT-proBNP and their association with clinical variables in the Japanese general working population by using baseline data from the Uranosaki cohort study. In the study, the plasma concentration of NT-proBNP and some biomarkers were measured in addition to the standard health checkups at the workplace. Questionnaires regarding health-related quality of life (HR-QOL) were also completed. A total of 2140 participants were enrolled in the study. Plasma levels of NT-proBNP were positively associated with age, female sex, systolic blood pressure, pulse pressure, prevalent hypertension, smoking habit, high-density lipoprotein cholesterol (HDL-C), and prevalent proteinuria, and negatively associated with body mass index, lipid profiles except HDL-C, uric acid, renal function, and hemoglobin. Both the plasma concentration of high-molecular weight adiponectin and that of high-sensitivity troponin T were positively and independently associated with NT-proBNP. In addition, the HR-QOL score regarding sleep disorder was independently associated with NT-proBNP. Thus, we have obtained evidence that the plasma NT-proBNP is affected by several clinical variables in the general working population.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
| | | | | | - Jun-Ichi Oyama
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masafumi Natsuaki
- Department of Internal Medicine, Imari Matsuura Hospital, Imari, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
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18
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Wang H, Gao Z, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Association of body mass index with mortality in Chinese patients after percutaneous coronary intervention: A large single-center data. Cardiovasc Ther 2017; 35. [PMID: 28467641 DOI: 10.1111/1755-5922.12271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/14/2017] [Accepted: 04/26/2017] [Indexed: 01/14/2023] Open
Affiliation(s)
- Huanhuan Wang
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Zhan Gao
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Xueyan Zhao
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Shubin Qiao
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Yuejin Yang
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Runlin Gao
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Bo Xu
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
| | - Jinqing Yuan
- Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Beijing China
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19
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Body mass index, carotid plaque, and clinical outcomes in patients with coronary artery disease. Coron Artery Dis 2017; 28:278-286. [DOI: 10.1097/mca.0000000000000467] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Johnson AP, Parlow JL, Milne B, Whitehead M, Xu J, Rohland S, Thorpe JB. Economies of scale: body mass index and costs of cardiac surgery in Ontario, Canada. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:471-479. [PMID: 27167229 DOI: 10.1007/s10198-016-0803-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/27/2016] [Indexed: 06/05/2023]
Abstract
An obesity paradox has been described, whereby obese patients have better health outcomes than normal weight patients in certain clinical situations, including cardiac surgery. However, the relationship between body mass index (BMI) and resource utilization and costs in patients undergoing coronary artery bypass graft (CABG) surgery is largely unknown. We examined resource utilization and cost data for 53,224 patients undergoing CABG in Ontario, Canada over a 10-year period between 2002 and 2011. Data for costs during hospital admission and for a 1-year follow-up period were derived from the Institute for Clinical Evaluative Sciences, and analyzed according to pre-defined BMI categories using analysis of variance and multivariate models. BMI independently influenced healthcare costs. Underweight patients had the highest per patient costs ($50,124 ± $36,495), with the next highest costs incurred by morbidly obese ($43,770 ± $31,747) and normal weight patients ($42,564 ± $30,630). Obese and overweight patients had the lowest per patient costs ($40,760 ± $30,664 and $39,960 ± $25,422, respectively). Conversely, at the population level, overweight and obese patients were responsible for the highest total yearly population costs to the healthcare system ($92 million and $50 million, respectively, compared to $4.2 million for underweight patients). This is most likely due to the high proportion of CABG patients falling into the overweight and obese BMI groups. In the future, preoperative risk stratification and preparation based on BMI may assist in reducing surgical costs, and may inform health policy measures aimed at the management of weight extremes in the population.
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Affiliation(s)
- Ana P Johnson
- Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Joel L Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Brian Milne
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Jianfeng Xu
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Susan Rohland
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Joelle B Thorpe
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
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Lee S. The Obesity Paradox in Colorectal Cancer Surgery: An Analysis of Korean Healthcare Big Data, 2012–2013. Nutr Cancer 2017; 69:248-253. [DOI: 10.1080/01635581.2017.1263744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sanghun Lee
- Department of Medical Consilience, Graduate School, Dankook University, Gyeonggi-do, South Korea
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22
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Tan XF, Shi JX, Chen AMH. Prolonged and intensive medication use are associated with the obesity paradox after percutaneous coronary intervention: a systematic review and meta-analysis of 12 studies. BMC Cardiovasc Disord 2016; 16:125. [PMID: 27267233 PMCID: PMC4895875 DOI: 10.1186/s12872-016-0310-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Obesity paradox is defined as the unexpected decrease in the total number of death which has been observed among patients who are overweight and obese compared to patients with normal weight after undergoing revascularization by percutaneous coronary intervention (PCI). Despite of so many recent studies which showed the existence of this phenomenon, prolonged and intensive medication use were only suggested to be among the reasons responsible for this ‘obesity paradox’ but it was never confirmed whether this hypothesis should really be considered true or not. Therefore, this study aimed to investigate whether prolonged and intensive medication use were associated with this obesity paradox after PCI. Methods Medline, PubMed, EMBASE and the Cochrane Library were searched for studies showing the existence of this ‘obesity paradox’ in patients who underwent coronary revascularization by PCI and only articles comprising of medication use among the patients analyzed were considered relevant for this research. Medication use among the different subgroups of patients was calculated. Mortality was considered as the clinical endpoint in this study. Risk Ratio (RR) with 95 % Confidence Interval (CI) was used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3. Results Twelve studies consisting of a total number of 91,582 patients was included in this meta-analysis. An intensive medication use after the hospital discharge and during the follow up period after PCI was observed in the subgroup of obese patients, followed by the overweight patients and the normal weight patients respectively. Our results showed that the short-term (30 days) mortality in overweight and obese patients was significantly lower compared to the normal weight patients with RR: 0.72; 95 % CI: 0.56-0.92, p = 0.008 and RR: 0.47, 95 % CI: 0.34-0.65; p < 0.00001 respectively. The long-term (≥ one year) mortality was also significantly lower in the overweight and the obese groups with RR: 0.74, 95 % CI: 0.67-0.82; p < 0.00001 and RR: 0.63, 95 % CI: 0.55-0.72; p < 0.00001 respectively. Conclusion Our study has confirmed to some extent, that prolonged and intensive use of medications which were more prominent in patients who were overweight and obese during the follow up period, might apparently be among the reasons responsible for this obesity paradox after PCI.
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Affiliation(s)
- Xiao-Feng Tan
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - Jia-Xin Shi
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China
| | - And Meng-Hua Chen
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China.
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Bundhun PK, Wu ZJ, Chen MH. Impact of Modifiable Cardiovascular Risk Factors on Mortality After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of 100 Studies. Medicine (Baltimore) 2015; 94:e2313. [PMID: 26683970 PMCID: PMC5058942 DOI: 10.1097/md.0000000000002313] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/05/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Modifiable cardiovascular risk factors such as obesity, hypertension, dyslipidemia, smoking, diabetes mellitus, and metabolic syndrome can easily give rise to coronary heart disease (CHD). However, due to the existence of the so-called "obesity paradox" and "smoking paradox," the impact of these modifiable cardiovascular risk factors on mortality after percutaneous coronary intervention (PCI) is still not clear. Therefore, in order to solve this issue, we aim to compare mortality between patients with low and high modifiable cardiovascular risk factors after PCI. Medline and EMBASE were searched for studies related to these modifiable cardiovascular risk factors. Reported outcome was all-cause mortality after PCI. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and the pooled analyses were performed with RevMan 5.3 software. A total of 100 studies consisting of 884,190 patients (330,068 and 514,122 with high and low cardiovascular risk factors respectively) have been included in this meta-analysis. Diabetes mellitus was associated with a significantly higher short and long-term mortality with RR 2.11; 95% CI: (1.91-2.33) and 1.85; 95% CI: (1.66-2.06), respectively, after PCI. A significantly higher long-term mortality in the hypertensive and metabolic syndrome patients with RR 1.45; 95% CI: (1.24-1.69) and RR 1.29; 95% CI: (1.11-1.51), respectively, has also been observed. However, an unexpectedly, significantly lower mortality risk was observed among the smokers and obese patients. Certain modifiable cardiovascular risk subgroups had a significantly higher impact on mortality after PCI. However, mortality among the obese patients and the smokers showed an unexpected paradox after coronary intervention.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
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Bundhun PK, Li N, Chen MH. Does an Obesity Paradox Really Exist After Cardiovascular Intervention?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Medicine (Baltimore) 2015; 94:e1910. [PMID: 26554791 PMCID: PMC4915892 DOI: 10.1097/md.0000000000001910] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Several studies have shown the existence of an obesity paradox after Percutaneous Coronary Intervention (PCI). However, other studies have shown its absence. This study sought to perform a systematic review and meta-analysis of studies comparing the mortality risk between high body mass index patients and normal weight patients after PCI.We have searched PubMed, Embase, and Chinese medical journal for randomized controlled trials (RCTs) and observational studies published between the year 2000 and 2015 by typing the keywords "percutaneous coronary intervention" and "obesity paradox." The main outcome was "all-cause mortality". RevMan 5.3 software was used to calculate the risk ratio (RR) with 95% confidence interval (CI) to express the pooled effect on discontinuous variables.Twenty-two studies have been included in this meta-analysis consisting of a total of 242,377 patients with 73,143 normal weight patients, 103,608 overweight, and 65,626 obese patients. Younger age, higher cardiovascular risk factors and the intensive use of medications have mainly been observed among obese patients followed by overweight and normal weight patients respectively. In-hospital, 12 months and ≥ 1 year (long-term) mortality risks were significantly lower in the overweight and obese groups with (RR: 0.67; 95% CI: 0.63-0.72, P < 0.00001) and (RR: 0.60; 95% CI: 0.56-0.65, P < 0.00001) respectively in the in-hospital follow-up (RR: 0.62; 95% CI: 0.55-0.71 and 0.57; 95% CI: 0.52-0.63, P < 0.00001) at 12 months, and (RR: 0.70; 95% CI: 0.64-0.76; P < 0.00001) and (RR: 0.80; 95% CI: 0.71-0.91, P = 0.0006) respectively for the long-term follow-up after PCI.This "obesity paradox" does exist after PCI. The mortality in overweight and obese patients is really significantly lower compared to the normal weight patients. However, the exact reasons for this phenomenon need further exploration and research in the future.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
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25
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The prognostic impact of worsening renal function in Japanese patients undergoing percutaneous coronary intervention with acute coronary syndrome. J Cardiol 2015; 66:326-32. [DOI: 10.1016/j.jjcc.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/12/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
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He PY, Yang YJ, Qiao SB, Xu B, Yao M, Wu YJ, Wu Y, Yuan JQ, Chen J, Liu HB, Dai J, Li W, Tang YD, Yang JG, Gao RL. Impact of body mass index on the clinical outcomes after percutaneous coronary intervention in patients ≥ 75 years old. Chin Med J (Engl) 2015; 128:638-43. [PMID: 25698196 PMCID: PMC4834775 DOI: 10.4103/0366-6999.151662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥ 75 years old remained unclear. METHODS A total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤ 20.0 kg/m 2 ), normal weight (20.0-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ) and obese (≥ 30.0 kg/m 2 ). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders. RESULTS Totally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old. CONCLUSIONS The BMI "obese paradox" was not found in patients ≥ 75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.
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Affiliation(s)
| | - Yue-Jin Yang
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Huang BT, Peng Y, Liu W, Zhang C, Huang FY, Wang PJ, Zuo ZL, Liao YB, Chai H, Huang KS, Huang DJ, Chen M. Lean mass index, body fat and survival in Chinese patients with coronary artery disease. QJM 2015; 108:641-7. [PMID: 25609701 DOI: 10.1093/qjmed/hcv013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND 'Obesity paradox' was not consistently observed in Asians with coronary artery disease (CAD). AIM The study investigated the association between body composition and outcomes in Chinese patients with CAD. DESIGN Cohort study. METHOD A total of 3280 patients with angiographically validated CAD were consecutively included. Body fat (BF) percentage and lean mass index (LMI) were evaluated using the Clínica Universidad de Navarra-Body Adiposity Estimator. The rate of mortality from any cause was compared across groups classified by the quartiles of LMI. RESULTS During a median period of 24 months, 288 (8.8%) participants died. There was a close association between increasing LMI and reducing mortality rate. However, univariate analyses did not find protective effect of BF on survival. After adjusting for age, sex, diabetes, current smoking, systolic blood pressure, creatinine, white blood cell count, haemoglobin and medication, Cox regression analyses showed that the significant relation between higher quartiles (Q) of LMI and survival benefit (Q4, hazard ratio 0.58 (95% confidence interval: 0.36-0.94) vs. Q3, 0.60 (0.39-0.91) vs. Q2, 0.60 (0.41-0.88) vs. Q1, reference) remained. CONCLUSION Low LMI but not BF predicts all-cause mortality in Chinese patients with CAD.
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Affiliation(s)
- B-T Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - Y Peng
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - W Liu
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - C Zhang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - F-Y Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - P-J Wang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - Z-L Zuo
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - Y-B Liao
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - H Chai
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - K-S Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - D-J Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
| | - M Chen
- From the Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Wuhou District, Chengdu 610041, China
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Kawabe M, Sato A, Hoshi T, Sakai S, Hiraya D, Watabe H, Kakefuda Y, Ishibashi M, Abe D, Takeyasu N, Aonuma K. Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome. J Cardiol 2015; 67:170-6. [PMID: 26228000 DOI: 10.1016/j.jjcc.2015.05.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/01/2015] [Accepted: 05/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Increased levels of uric acid (UA) have been associated with cardiovascular disease. This association is generally stronger in women than men. However, gender differences in the prognostic value of UA in patients with acute coronary syndrome (ACS) are unknown. We investigated gender differences in the relationship between UA level and the prognosis in patients with ACS. METHOD This was an observational analysis of patients with ACS undergoing percutaneous coronary intervention enrolled in the Ibaraki Cardiac Assessment Study (ICAS) registry. We analyzed 1380 patients (330 women, 1050 men) with ACS who had information on UA. We assessed the association between UA and the incidence of major cardiovascular adverse events (MACE), defined as all-cause death, congestive heart failure, reinfarction, and stroke. Patients were divided according to gender-specific UA quartile. RESULTS The mean UA level in women was significantly lower than that in men (4.9mg/dl vs 5.9mg/dl, p<0.001). After a median duration of follow-up period of 437 days (interquartile range 222-801 days), MACE had occurred in 186 (13%) patients [56 (17%) events in women; 130 (12%) events in men]. Kaplan-Meier analysis for MACE-free survival demonstrated that a higher quartile of UA was associated with MACE in both women and men (p<0.001, p=0.002, respectively). Multivariate Cox regression analysis revealed that the highest quartile of UA, as compared with the lowest quartile of UA, was an independent predictor of MACE in women [hazard ratio (HR), 2.84; 95% CI, 1.19-6.77; p=0.018] but not in men (HR, 1.32; 95% CI, 0.66-2.64; p=0.422). CONCLUSIONS An increased level of UA was associated with MACE more strongly in women than in men with ACS. These results suggest that there are gender differences in the association of UA level with the prognosis in patients with ACS.
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Affiliation(s)
- Masayuki Kawabe
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Tomoya Hoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shunsuke Sakai
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Daigo Hiraya
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Watabe
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuki Kakefuda
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mayu Ishibashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Daisuke Abe
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan
| | - Noriyuki Takeyasu
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Doehner W. Critical appraisal of the obesity paradox in cardiovascular disease: how to manage patients with overweight in heart failure? Heart Fail Rev 2015; 19:637-44. [PMID: 24554113 DOI: 10.1007/s10741-014-9425-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Overweight has been shown in multiple studies to carry a survival benefit in heart failure (HF) patients. This finding is, of course, counterintuitive to the well-established role of obesity as a modifiable risk factor for incident cardiovascular disease. The debate on the relevance of this obesity paradox is on-going, and clinical, methodological and teleological aspects are discussed. Particularly, younger age and a seemingly favourable clinical status of obese patients are repeatedly discussed together with the lack of prospective data to question the validity of the observed survival advantage in obese HF patients. Recent risk score calculators, however, have included body weight as an inverse risk factor, i.e. higher body mass index is predicting better outcome. Emerging prospective interventional trials support the concept that in patients with established disease, intentional weight reduction may not necessarily translate into improved outcome. The clinically most relevant consequence from the emerging data is, of course, the practical recommendation on body weight management that we may give our (overweight) patients. While the terminology as a paradox is critically discussed, a more differentiated concept for weight management should be emphasized that distinguishes between healthy subjects and those with an established cardiovascular disease such as heart failure.
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Affiliation(s)
- Wolfram Doehner
- Centre for Stroke Research Berlin and Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Numasawa Y, Kohsaka S, Miyata H, Kawamura A, Noma S, Suzuki M, Nakagawa S, Momiyama Y, Naito K, Fukuda K. Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry. PLoS One 2015; 10:e0124399. [PMID: 25874887 PMCID: PMC4397046 DOI: 10.1371/journal.pone.0124399] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/01/2015] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan
- * E-mail:
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- University of Tokyo, Healthcare Quality Assessment, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization, Saitama National Hospital, Saitama, Japan
| | - Susumu Nakagawa
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Yukihiko Momiyama
- Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Kotaro Naito
- Department of Cardiology, Keiyu Hospital, Kanagawa, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Okada M, Kakehashi M. The influence of body mass index and outdoor temperature on the autonomic response to eating in healthy young Japanese women. SPRINGERPLUS 2015; 3:142. [PMID: 25674443 PMCID: PMC4320179 DOI: 10.1186/2193-1801-3-142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The influences of body weight and air temperature on the autonomic response to food intake have not been clarified. We measured heart rate variability before and after lunch, as well as the effects of outdoor temperature and increased body mass index (BMI), in healthy young Japanese women. METHODS We studied 55 healthy young female university students. Heart rate variability was measured before lunch, immediately after lunch, 30 min after lunch, and 1 h after lunch to determine any correlations between heart rate variability, outdoor temperature, and BMI. In addition, multiple regression analysis was performed to elucidate the relationship between heart rate variability and outdoor temperature before and after lunch. A simple slope test was conducted to show the relationship between the low-to-high frequency ratio (1 h after lunch) and outdoor temperature. RESULTS Subjects were divided into a low BMI group (range: 16.6-20.3) and a high BMI group (range: 20.4-32.9). The very low frequency component of heart rate variability, an index of thermoregulatory vasomotor control exerted by the sympathetic nervous system, was significantly diminished after lunch in the high BMI group (P < 0.01). A significant decrease in the low-to-high frequency (LF/HF) ratio, which represents the balance between the parasympathetic and sympathetic nervous systems, was evident in the low BMI group after lunch, indicating parasympathetic system dominance (P = 0.001). In addition, a significant association was found between the LF/HF ratio and outdoor temperature after lunch with a lower BMI (P = 0.002), but this association disappeared with higher BMIs. CONCLUSION Autonomic responses to eating showed clear differences according to BMI, indicating that the sensitivity of the autonomic nervous system may change with increases in BMI.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, 731-0136 Japan
| | - Masayuki Kakehashi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, 734-8553 Japan
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Kaneko H, Suzuki S, Goto M, Arita T, Yuzawa Y, Yagi N, Murata N, Kato Y, Kano H, Matsuno S, Otsuka T, Uejima T, Oikawa Y, Sagara K, Nagashima K, Kirigaya H, Sawada H, Aizawa T, Yajima J, Yamashita T. Incidence and Predictors of Rehospitalization of Acute Heart Failure Patients. Int Heart J 2015; 56:219-25. [DOI: 10.1536/ihj.14-290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Masato Goto
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yasufumi Yuzawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Nobuhiro Murata
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Koichi Sagara
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | | | - Hajime Kirigaya
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Hitoshi Sawada
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Tadanori Aizawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute
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Obesity paradox not observed among patients with angiographically proved coronary artery disease in southern China. J Cardiol 2014; 64:508-9. [DOI: 10.1016/j.jjcc.2014.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/30/2014] [Indexed: 11/18/2022]
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Kaneko H, Suzuki S, Uejima T, Kano H, Matsuno S, Takai H, Oikawa Y, Yajima J, Aizawa T, Yamashita T. Functional mitral regurgitation and left ventricular systolic dysfunction in the recent era of cardiovascular clinical practice, an observational cohort study. Hypertens Res 2014; 37:1082-7. [PMID: 25164208 DOI: 10.1038/hr.2014.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 11/09/2022]
Abstract
Functional mitral regurgitation (MR) is frequently associated with left ventricular systolic dysfunction (LVSD). Ventricular volume overload that occurs in patients with MR may lead to a progression of myocardial dysfunction. However, the prevalence and clinical outcomes of functional MR in Japanese patients with LVSD remain unclear. The aim of the present study is to clarify the prevalence and prognosis of functional MR in Japanese LVSD patients in the contemporary era. We followed patients with LVSD (LV ejection fraction (LVEF) ⩽ 40%) who were listed within a single, hospital-based cohort in the Shinken Database from 2004 to 2011, which was composed of all new patients (n = 17,517) who visited the Cardiovascular Institute. A total of 506 patients were included: 86 FMR (moderate-to-severe functional MR) patients and 420 non-FMR (none or mild functional MR) patients. FMR patients were older, had lower rates of hypertension and ischemic heart disease but had higher rates of chronic kidney disease, dilated cardiomyopathy and New York Heart Association III/IV classification. FMR patients had higher brain natriuretic peptide levels and lower LVEF. The Kaplan-Meier curves revealed that the incidence of all-cause death, cardiovascular death and heart failure (HF) admission was significantly higher in FMR patients. The presence of FMR was independently associated with a significantly higher risk of composite end point, including all-cause death and/or HF admission (hazard ratio 1.551, 95% confidence interval 1.045-2.303, P = 0.029). FMR was common in Japanese patients with LVSD and was associated with adverse long-term outcomes. Future study is warranted to establish the optimal therapeutic strategy for FMR and LVSD.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hideaki Takai
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tadanori Aizawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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Kaneko H. Author's reply: To PMID 23706354. J Cardiol 2014; 64:509. [PMID: 25062785 DOI: 10.1016/j.jjcc.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
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Kaneko H, Suzuki S, Kano H, Matsuno S, Otsuka T, Takai H, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Sagara K, Tanabe H, Sawada H, Aizawa T, Yamashita T. Impact of atrial fibrillation on long-term clinical outcomes in outpatients with heart failure. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Assessment of clinical factors associated with a successful catheter ablation outcome in younger patients with atrial fibrillation. J Cardiol 2014; 63:438-43. [DOI: 10.1016/j.jjcc.2013.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/30/2013] [Accepted: 10/18/2013] [Indexed: 01/08/2023]
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Yang YM, Shao XH, Zhu J, Zhang H, Liu Y, Gao X, Liu LS, Yu LT, Zhao L, Yu PF, Zhang H, He Q, Gu XD. Risk factors and incidence of stroke and MACE in Chinese atrial fibrillation patients presenting to emergency departments: A national wide database analysis. Int J Cardiol 2014; 173:242-7. [DOI: 10.1016/j.ijcard.2014.02.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/15/2014] [Accepted: 02/22/2014] [Indexed: 11/27/2022]
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The authors reply. Crit Care Med 2014; 42:e253. [PMID: 24534993 DOI: 10.1097/ccm.0000000000000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin GM, Li YH, Lin CL, Wang JH, Han CL. The "obesity-mortality paradox" phenomenon among Asian patients following percutaneous coronary artery intervention. J Cardiol 2013; 62:379. [PMID: 24060525 DOI: 10.1016/j.jjcc.2013.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Gen-Min Lin
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan; Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan.
| | - Yi-Hwei Li
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan
| | - Chin-Lon Lin
- Division of Cardiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Ji-Hung Wang
- Division of Cardiology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Chih-Lu Han
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Kaneko H, Suzuki S, Uejima T, Kano H, Matsuno S, Otsuka T, Takai H, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Sagara K, Tanabe H, Sawada H, Aizawa T, Yamashita T. Prevalence and the long-term prognosis of functional mitral regurgitation in Japanese patients with symptomatic heart failure. Heart Vessels 2013; 29:801-7. [PMID: 24275908 DOI: 10.1007/s00380-013-0448-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/18/2013] [Indexed: 01/20/2023]
Abstract
Functional mitral regurgitation (FMR) is a common and critical condition in patients with heart failure (HF); however, the prevalence and clinical outcome of FMR in Japanese real-world clinical practice remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2011, which comprised all new patients (n = 17,517) who visited the Cardiovascular Institute, we followed symptomatic HF patients. A total of 1,701 patients were included: 104 FMR patients (who had moderate to severe FMR) and 1,597 non-FMR patients (who had none or mild FMR). FMR patients had lower rates of hypertension and dyslipidemia, but higher rates of dilated cardiomyopathy, atrial fibrillation, and New York Heart Association functional class III/IV. FMR patients had higher levels of brain natriuretic peptide and lower left ventricular function. Use of cardiovascular drugs was more common among FMR patients. Kaplan-Meier curves revealed that the incidences of all-cause death, cardiovascular death, and admission for HF were significantly higher in FMR patients. The adjusted Cox regression analysis showed that significant FMR was associated with higher incidences of all-cause death [hazard ratio (HR) 2.179, 95 % confidence interval (CI) 1.266-3.751; P = 0.005], cardiovascular death (HR 2.371, 95 % CI 1.157-4.858; P = 0.018), and admission for HF (HR 1.819, 95 % CI 1.133-2.920; P = 0.013). FMR was common in Japanese symptomatic HF patients and was associated with adverse long-term outcomes. Establishing optimal therapeutic strategies for FMR is warranted.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-ku, Tokyo, 106-0031, Japan,
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