Abstract
Background
Waist circumference (WC) and body mass index (BMI) are clinically used to assess adiposity.
The aim of the present study was to evaluate the association of WC with postoperative
morbidity and mortality in patients who underwent isolated coronary artery bypass
grafting (CABG) in relation to patients' BMI category.
Methods
We analyzed the associations of WC and BMI with short-term postoperative outcomes
in a cohort of 7446 patients who underwent isolated CABG. We performed univariate
and adjusted analyses on main postoperative outcomes after CABG for WC and BMI.
Results
Adverse events researched included postoperative mortality, intensive care unit and
hospital length of stay, cardiovascular and cerebrovascular events, respiratory complications,
infectious, hemostasis complications, and renal complications. WC was independently
associated with all postoperative outcomes except prolonged intubation and mortality.
Overall, patients in the upper WC quartile in each BMI category were at increased
risk of adverse events compared with patients in the lower 3 WC quartiles, with a
maximal incremental risk of 1.91 (95% confidence interval, 1.23-2.95) among patients
with a BMI ≥ 35. This association was observed for men and women, across all overweight
and obesity categories. Neither WC nor BMI was associated with short-term postoperative
mortality.
Conclusions
In our large cohort of patients who underwent isolated CABG, WC was significantly
associated with clinical adverse events, independently of BMI. These findings provide
further evidence on the added value of measuring WC as a simple and easy to measure
anthropometric marker to refine risk assessment beyond BMI among patients who undergo
CABG.
Résumé
Introduction
Dans la pratique clinique, le tour de taille et l’indice de masse corporelle (IMC)
sont utilisés pour évaluer l’adiposité. Le but de la présente étude consistait à évaluer
le lien entre le tour de taille et la morbidité/mortalité postopératoires chez des
patients ayant subi un pontage aorto-coronarien isolé en relation avec leur catégorie
d’IMC.
Méthodes
Nous avons analysé le lien entre le tour de taille, l’IMC et les résultats postopératoires
à court terme dans une cohorte de 7 446 patients ayant subi un pontage aorto-coronarien
isolé. Nous avons réalisé des analyses univariées multivariées avec ajustement sur
les principaux résultats postopératoires après un pontage aorto-coronarien, pour le
tour de taille et l’IMC.
Résultats
Les événements indésirables analysés comprenaient la mortalité postopératoire, la
durée du séjour à l’hôpital et aux soins intensifs, les manifestations cardiovasculaires
et vasculaires cérébrales, les complications respiratoires, les infections, l’hémostasie
et les complications rénales. Nous avons établi association indépendante entre le
tour de taille et tous les résultats postopératoires, à l’exception de l’intubation
prolongée et de la mortalité. D’une manière générale, les patients ayant un tour de
taille se situant dans le quartile supérieur dans chacune des catégories d’IMC étaient
exposés à un risque accru d’événements indésirables, comparativement à ceux dont le
tour de taille se situait dans les trois quartiles inférieurs, le rapport de cote
maximal étant de 1,91 (intervalle de confiance à 95 % : 1,23 – 2,95) chez les patients
dont l’IMC était ≥ 35. Cette association a été observé chez les hommes et chez les
femmes, dans toutes les catégories de surpoids et d’obésité. Ni le tour de taille
ni l’IMC n’ont été associés à la mortalité postopératoire à court terme.
Conclusions
Dans notre vaste cohorte de patients ayant subi un pontage aorto-coronarien isolé,
une association significative a été étabeli entre le tour de taille et certains événements
indésirables cliniques, indépendamment de l’IMC. Ces résultats viennent confirmer
l’intérêt du tour de taille en tant que marqueur anthropométrique simple et facile
à mesurer pour mieux évaluer le risque, au-delà de l’IMC, chez les patients qui subissent
un pontage aorto-coronarien.
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Article info
Publication history
Published online: July 07, 2015
Accepted:
June 24,
2015
Received:
April 27,
2015
Footnotes
See page 333 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
