PLoS ONE (Jan 2022)

The association between different body mass index levels and midterm surgical revascularization outcomes.

  • Farzad Masoudkabir,
  • Negin Yavari,
  • Mana Jameie,
  • Mina Pashang,
  • Saeed Sadeghian,
  • Mojtaba Salarifar,
  • Arash Jalali,
  • Seyed Hossein Ahmadi Tafti,
  • Kiomars Abbasi,
  • Abbas Salehi Omran,
  • Shahram Momtahen,
  • Soheil Mansourian,
  • Mahmood Shirzad,
  • Jamshid Bagheri,
  • Khosro Barkhordari,
  • Abbasali Karimi

DOI
https://doi.org/10.1371/journal.pone.0274129
Journal volume & issue
Vol. 17, no. 9
p. e0274129

Abstract

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BackgroundThere are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed "the obesity paradox". This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG.MethodsThis historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMIResultsOf 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints.ConclusionsOur findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.