Obesity paradox and perioperative myocardial infarction/injury in non-cardiac surgery
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ORIGINAL PAPER
Obesity paradox and perioperative myocardial infarction/injury in non‑cardiac surgery Reka Hidvegi1,2 · Christian Puelacher1,3 · Danielle M. Gualandro1,4 · Andreas Lampart3 · Giovanna Lurati Buse5 · Angelika Hammerer‑Lerchner6 · Joan Walter1,2 · Marcel Liffert1,2 · Daniel Bolliger2 · Luzius Steiner2 · Christoph Kindler7 · Jaqueline Espinola7 · Ivo Strebel1 · Johanna Gueckel1,3 · Stella Marbot1,3 · Ketina Arslani1,3 · Jasper Boeddinghaus1 · Thomas Nestelberger1 · Tobias Zimmermann1,3 · Michael Freese1 · Lorenz Guerke8 · Edin Mujagic8 · Daniel Rikli9 · Andreas Buser10 · Christian Mueller1 · for the BASEL-P.M.I. Investigators Received: 15 September 2019 / Accepted: 17 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The impact of obesity on the incidence of perioperative myocardial infarction/injury (PMI) and mortality following non-cardiac surgery is not well understood. Methods We performed a prospective diagnostic study enrolling consecutive patients undergoing non-cardiac surgery, who were considered at increased cardiovascular risk. All patients were screened for PMI, defined as an absolute increase from preoperative to postoperative sensitive/high-sensitivity cardiac troponin T (hs-cTnT) concentrations. The body mass index (BMI) was classified according to the WHO classification (underweight 40 kg/m2). The incidence of PMI and all-cause mortality at 365 days, both stratified according to BMI. Results We enrolled 4277 patients who had undergone 5413 surgeries. The median BMI was 26 kg/m2 (interquartile range 23–30 kg/m2). Incidence of PMI showed a non-linear relationship with BMI and ranged from 12% (95% CI 9–14%) in obesity class I to 19% (95% CI 17–42%) in the underweight group. This was confirmed in multivariable analysis with obesity class I. showing the lowest risk (adjusted OR 0.64; 95% CI 0.49–0.83) for developing PMI. Mortality at 365 days was lower in all obesity groups compared to patients with normal body weight (e.g., unadjusted OR 0.54 (95% CI 0.39–0.73) and adjusted OR 0.52 (95% CI 0.38–0.71) in obesity class I). Conclusion Obesity class I was associated with a lower incidence of PMI, and obesity in general was associated with a lower all-cause mortality at 365 days. Keywords Perioperative myocardial infarction/injury · Body mass index · Obesity paradox Abbreviations ASA American Society of Anesthesiologists BMI Body mass index CAD Coronary artery disease CI Confidence interval Reka Hidvegi and Christian Puelacher contributed to this manuscript and should be considered co-first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01605-0) contains supplementary material, which is available to authorized users. * Christian Puelacher [email protected] Extended author information available on the last page of the article
COPD Chronic obstructive pulmonary disease ECG Electrocardiography ESC European Society of Cardiology ESA European Society of Anesthes
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