Objectives. The purpose of this study was to determine whether there is a dose-response relationship between body mass index (BMI) and all-cause mortality in patients after coronary revascularization. Methods. The MIMIC-III database (version 1.4) was used as the sample population. For variables with less than 10% of values missing, we used the mice package of R software for multiple imputations. Cox regression was used to determine the risk factors of all-cause mortality in patients. RCSs were used to observe the relationship between BMI and all-cause mortality. Additional subgroup and sensitivity analyses were also performed to explore whether the conclusion can be applied to specific groups. Results. Both univariate and multivariate Cox models indicated that the mortality risk was lower for overweight patients than for normal-weight patients (). In RCS models, BMI had a U-shaped relationship with all-cause mortality of patients after coronary artery bypass grafting (CABG) ( for nonlinearity = 0.0028). There was a weak U-shaped relationship between BMI and all-cause mortality after percutaneous coronary intervention (PCI), but the nonlinear relationship between these two parameters was not significant ( for nonlinearity = 0.1756). Conclusions. The obesity paradox does exist in patients treated with CABG and PCI. RCS analysis indicated that there was a U-shaped relationship between BMI and all-cause mortality in patients after CABG. After sex stratification, the relationship between BMI and all-cause mortality in male patients who received PCI was L-shaped, while the nonlinear relationship among females was not significant.

中文翻译：

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4,133 例冠状动脉血运重建术患者全因死亡率的肥胖悖论

目标。本研究的目的是确定冠状动脉血运重建后患者的体重指数（BMI）与全因死亡率之间是否存在剂量反应关系。方法。MIMIC-III 数据库（1.4 版）被用作样本人群。对于缺失值少于 10% 的变量，我们使用 R 软件的 mouse 软件包进行多重插补。Cox回归用于确定患者全因死亡率的危险因素。RCS用于观察BMI与全因死亡率之间的关系。还进行了额外的亚组和敏感性分析，以探索该结论是否可以应用于特定组。结果. 单变量和多变量 Cox 模型均表明，超重患者的死亡风险低于正常体重患者。）。在 RCS 模型中，BMI 与冠状动脉旁路移植术 (CABG) 后患者的全因死亡率呈 U 型关系（非线性度 = 0.0028）。经皮冠状动脉介入治疗 (PCI) 后 BMI 与全因死亡率之间存在微弱的 U 型关系，但这两个参数之间的非线性关系不显着（非线性度 = 0.1756）。结论。在接受 CABG 和 PCI 治疗的患者中确实存在肥胖悖论。RCS分析表明，CABG术后患者的BMI与全因死亡率之间存在U型关系。性别分层后，接受PCI的男性患者BMI与全因死亡率的关系为L形，而女性之间的非线性关系不显着。