Relationship of body mass index to clinical outcomes after percutaneous coronary intervention

In-hospital outcomes in metabolically healthy and unhealthy individuals over 65 years of age with obesity undergoing percutaneous intervention for acute coronary syndrome: A nationwide propensity-matched analysis (2016-2020)

Background

The obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our study aims to evaluate the in-hospital outcomes of percutaneous coronary intervention (PCI) in metabolically healthy individuals with obesity (MHO) and metabolically unhealthy (MUHO) individuals with obesity over 65 years of age with acute coronary syndrome (ACS) between 2016 and 2020.

Methods

This was a retrospective and observational study. Patients were identified through utilizing the National Inpatient Sample (NIS) Database (2016-2020) and ICD-10 codes. By employing a t-test and Pearson's Chi-square test, we assessed and contrasted the initial attributes, concurrent conditions, and results pertaining to all-cause mortality (ACM), cardiogenic shock (CS), length of stay (LOS), and hospitalization expense. Moreover, propensity score matching was conducted in a 1:1 ratio with respect to age, gender, and race. We also utilized multivariable logistic regression to compare MHO and MUHO in terms of the impact on all-cause mortality.

Results

Out of a total of 135,395 patients identified, 2995 patients with MUHO were matched with 2995 MHO patients. Patients in the MUHO group had a higher prevalence of chronic pulmonary disease (24.9 % vs. 19.5 %), peripheral vascular disease (9.3 % vs. 6.7 %), hypothyroidism (16 % vs. 11.5 %), prior myocardial infarction (15.9 % vs. 6.2 %), and prior stroke (7.5 % vs. 2.8 %). Patients in the MHO group had a higher ACM (12.4 % vs. 2.8 %, p < 0.001), CS (18.55 % vs. 7 %, p < 0.001), stroke (2.2 % vs. 1 %, p < 0.001), ventricular assist device insertions (5.2 % vs. 2.7 %, p < 0.001), and IABP insertions (8.8 % vs. 3.8 %) compared to the MUHO cohort.

Conclusion

Our study revealed an obesity paradox in individuals over 65 years of age undergoing PCI demonstrating worse outcomes, including higher in-hospital mortality, CS, stroke, Ventricular assist device and IABP insertion in MHO patients compared to the MUHO cohort.

Impact of body mass index on long-term outcomes in patients undergoing percutaneous coronary intervention stratified by diabetes mellitus: a retrospective cohort study

BACKGROUND

Patients with diabetes mellitus (DM) caused by obesity have increased in recent years. The impact of obesity on long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) with or without DM remains unclear.

METHODS

We retrospectively analysed data from 1918 patients who underwent PCI. Patients were categorized into four groups based on body mass index (BMI, normal weight: BMI < 25 kg/m2; overweight and obese: BMI ≥ 25 kg/m2) and DM status (presence or absence). The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as all-cause death, myocardial infarction, stroke, and unplanned repeat revascularization).

RESULTS

During a median follow-up of 7.0 years, no significant differences in MACCE, myocardial infarction, or stroke were observed among the four groups. Overweight and obese individuals exhibited lower all-cause mortality rates compared with normal-weight patients (without DM: hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.37 to 0.78; with DM: HR: 0.57, 95% CI: 0.38 to 0.86). In non-diabetic patients, the overweight and obese group demonstrated a higher risk of unplanned repeat revascularization than the normal-weight group (HR:1.23, 95% CI:1.03 to 1.46). After multivariable adjustment, overweight and obesity were not significantly associated with MACCE, all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization in patients with and without diabetes undergoing PCI.

CONCLUSION

Overweight and obesity did not demonstrate a significant protective effect on long-term outcomes in patients with and without diabetes undergoing PCI.

A Cohort Study of the Effects of Integrated Medical and Nursing Rounds Combined with AIDET Communication Mode on Recovery and Quality of Life in Patients Undergoing Percutaneous Coronary Intervention

Objective

To explore the influence of the communication mode of "Acknowledge, Introduce, Duration, Explanation, and Thanks (AIDET)" on the postoperative recovery and quality of life of patients undergoing percutaneous coronary intervention.

Methods

Sixty patients with percutaneous coronary intervention in our hospital from April 2019 to April 2021 were selected. The patients were randomly divided into a control group (n = 30) and research group (n = 30). The control group received integrated medical and nursing rounds, and the research group received integrated medical and nursing rounds combined with AIDET communication mode. The scores of nursing satisfaction, cardiac function, self-nursing ability, short-term prognosis, and quality of life were compared between the two groups.

Results

In the comparison of nursing satisfaction between the two groups, the satisfaction of the research group was low in 1 case, moderate in 6 cases, and high in 27 cases, with a satisfaction rate of 96.67%. In the control group, there were 7 cases with low satisfaction, 10 cases with moderate satisfaction, and 13 cases with high satisfaction, with a satisfaction rate of 76.67%. The nursing satisfaction of the research group was higher than that of the control group, and the difference was statistically significant, and the difference was statistically significant (P < 0.05). After intervention, the cardiac function of the two groups was improved. The LVEF and LVESVI of the research group were higher than those of the control group, while the WMSI of the research group was lower than that of the control group (P < 0.05). In the comparison of self-nursing ability, the self-nursing maintenance, self-nursing management, self-nursing confidence, and total score of self-nursing in the research group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence rates of acute myocardial infarction (AMI), revascularization, arrhythmia, heart failure, cardiogenic shock, and cardiac death in the research group were obviously lower than those in the control group, and the difference was statistically significant (P < 0.05). After intervention, the scores of quality of life of the two groups decreased, and the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower than those in the control group (P < 0.05).

Conclusion

Medical and nursing integrated ward rounds combined with AIDET communication mode can effectively improve the prognosis of patients undergoing percutaneous coronary intervention to promote the establishment of a harmonious nurse-patient relationship. The patients' self-care ability is able to be effectively enhanced.