Key result
Preoperative obesity (BMI > 30 kg/m2) was associated with increased 5-year mortality and MACCEs after CABG, with BMI ≥ 40 showing a trend for higher MACCE risk (HR 1.32; 95% CI 0.89-1.95).
Why the study?
Conflicting results exist regarding the relationship between overweight or obesity and outcomes after CABG, known as the obesity paradox.
Does preoperative obesity increase the risk of 5-year all-cause mortality and MACCEs in patients undergoing isolated CABG?
Cohort (n=17,602)
No
Does preoperative obesity increase the risk of 5-year all-cause mortality and MACCEs in patients undergoing isolated CABG?
Hazard Ratio: 1.32 (95% CI 0.89–1.95)
Preoperative obesity (BMI > 30 kg/m2) is associated with an increased risk of 5-year all-cause mortality and MACCEs following isolated CABG, challenging the concept of an 'obesity paradox' in this population.
Supports risk stratification in obese CABG patients; challenges obesity paradox yet leaves open need for prospective trials.
BACKGROUND: There 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. METHODS: This 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≤BMI<25, 25≤BMI<30, 30≤BMI<35, 35≤BMI<40, and BMI≥40. Patients with BMIs below 18.5 kg/m2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. RESULTS: Of 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. CONCLUSIONS: Our 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.
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Masoudkabir et al. (2022) conducted a cohort in Coronary artery bypass graft surgery (CABG) (n=17,602). Preoperative obesity (BMI > 30 kg/m2) vs. Pre-obesity and normal weight (BMI < 30 kg/m2) was evaluated on 5-year all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs) (HR 1.32, 95% CI 0.89-1.95). Preoperative obesity (BMI > 30 kg/m2) was associated with increased 5-year mortality and MACCEs after CABG, with BMI ≥ 40 showing a trend for higher MACCE risk (HR 1.32; 95% CI 0.89-1.95).
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