医学
超重
肥胖悖论
基里普班
心肌梗塞
内科学
体质指数
心力衰竭
肥胖
心脏病学
回顾性队列研究
人口
优势比
队列
经皮冠状动脉介入治疗
环境卫生
作者
Kenichi Matsushita,Sunao Kojima,Kyoko Hirakawa,Noriaki Tabata,Miwa Ito,Kenshi Yamanaga,Koichiro Fujisue,Tadashi Hoshiyama,Shinsuke Hanatani,Daisuke Sueta,Hisanori Kanazawa,Seiji Takashio,Yuichiro Arima,Satoshi Araki,Hiroki Usuku,Satoru Suzuki,Eiichiro Yamamoto,Taishi Nakamura,Hirofumi Soejima,Koichi Kaikita,Kenichi Tsujita
标识
DOI:10.1016/j.pcad.2022.11.020
摘要
The existence of a paradoxical association between overweight/obesity and survival benefits, the so-called obesity paradox, in heart failure (HF) as well as coronary artery disease (CAD) remains contentious. Previously, we reported that a past history of CAD negated the obesity paradox in the general population with acute HF. Herein, we further focused on HF complicating acute myocardial infarction (AMI) and compared the prognostic effects of overweight/obesity with respect to the severity of HF.We conducted a multicenter retrospective study of 7265 consecutive patients with AMI. The severity of HF was categorized according to the Killip classification. Overweight/obesity was defined as a body mass index (BMI) of ≥25 kg/m2. The interaction between overweight/obesity and the Killip classification for in-hospital mortality was tested in the entire cohort. Multivariable logistic regression analyses were performed to examine the effects of overweight/obesity on in-hospital mortality.Across the entire study cohort, 1931 patients had HF. Overweight/obesity had a significant association with reductions in in-hospital mortality in patients with mild HF (Killip class II; odds ratio [OR], 0.284; P = 0.019). Conversely, overweight/obesity was a significant risk factor for in-hospital mortality in patients with severe HF (Killip class IV; OR, 2.152; P = 0.001). The effects of overweight/obesity on in-hospital mortality in patients with moderate HF (Killip class III) were intermediate between those with mild HF and severe HF.Opposing effects of overweight/obesity on in-hospital mortality in patients with mild HF versus severe HF were demonstrated, suggesting a balance between beneficial and deleterious effects of overweight/obesity may be inclined toward the latter with the severity of HF complicating AMI.
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