Body mass index and outcome after revascularization for symptomatic carotid artery stenosis

作者：Volkers Eline J^*; Greving Jacoba P; Hendrikse Jeroen; Algra Ale; Kappelle L Jaap; Becquemin Jean Pierre; Bonati Leo H; Brott Thomas G; Bulbulia Richard; Calvet David; Eckstein Hans Henning; Fraedrich Gustav; Gregson John; Halliday Alison; Howard George; Jansen Olav; Roubin Gary S; Brown Martin M; Mas Jean Louis; Ringleb Peter A

来源：Neurology, 2017, 88(21): 2052-2060.

DOI：10.1212/WNL.0000000000003957

Objective: To determine whether the obesity paradox exists in patients who undergo carotid artery stenting (CAS) or carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.
Methods: We combined individual patient data from 2 randomized trials (Endarterectomy vs Angioplasty in Patients with Symptomatic Severe Carotid Stenosis and Stent-Protected Angioplasty vs Carotid Endarterectomy) and 3 centers in a third trial (International Carotid Stenting Study). Baseline body mass index (BMI) was available for 1,969 patients and classified into 4 groups <20, 20-<25, 25-<30, and >= 30 kg/m(2). Primary outcome was stroke or death, investigated separately for the periprocedural and postprocedural period (<= 120 days/>120 days after randomization). This outcome was compared between different BMI strata in CAS and CEA patients separately, and in the total group. We performed intention-to-treat multivariable Cox regression analyses.
Results: Median follow-up was 2.0 years. Stroke or death occurred in 159 patients in the periprocedural (cumulative risk 8.1%) and in 270 patients in the postprocedural period (rate 4.8/100 person-years). BMI did not affect periprocedural risk of stroke or death for patients assigned to CAS (p(trend) = 0.39) or CEA (p(trend) = 0.77) or for the total group (p(trend) = 0.48). Within the total group, patients with BMI 25-<30 had lower postprocedural risk of stroke or death than patients with BMI 20-<25 (BMI 25-<30 vs BMI 20-<25; hazard ratio 0.72; 95% confidence interval 0.55-0.94).
Conclusions: BMI is not associated with periprocedural risk of stroke or death; however, BMI 25-<30 is associated with lower postprocedural risk than BMI 20-<25. These observations were similar for CAS and CEA.

• 出版日期2017-5-23