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The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass

Gabby Elbaz-Greener1,2, Guy Rozen3,4,5, Shemy Carasso6,7

  • 1Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.

Frontiers in Cardiovascular Medicine
|October 25, 2021
PubMed

Insights

The obesity paradox in coronary artery bypass grafting (CABG) patients shows a U-shaped relationship between Body Mass Index (BMI) and mortality. Both underweight and extremely obese patients face higher risks after CABG surgery.

Area of Science:

  • Cardiology
  • Clinical Outcomes Research
  • Public Health

Background:

  • The relationship between Body Mass Index (BMI) and outcomes after coronary artery bypass grafting (CABG) is debated.
  • Real-world data is needed to clarify BMI's impact on in-hospital outcomes and mortality in CABG patients.

Purpose of the Study:

  • To examine the association between BMI and in-hospital mortality and clinical course in patients undergoing CABG.
  • To investigate the
  • obesity paradox
  • in a large, real-world cohort of CABG patients.

Main Methods:

  • Analysis of a sampled cohort of 48,710 coronary artery bypass grafting (CABG) hospitalizations from the National Inpatient Sample (NIS) database (October 2015 - December 2016).
  • Patients categorized into six BMI (kg/m2) subgroups: underweight (≤19), normal (20-25), overweight (26-30), obese I (31-35), obese II (36-39), and extremely obese (≥40).
  • Multivariable logistic and linear regression models used to assess predictors of in-hospital mortality and length of stay (LOS), respectively.

Main Results:

  • A U-shaped relationship observed between BMI and outcomes, with higher mortality and longer length of stay (LOS) in underweight (≤19 kg/m2) and extremely obese (≥40 kg/m2) patients compared to normal-weight individuals.
  • Multivariable analysis identified BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 as independent predictors of in-hospital mortality.
  • The study analyzed 48,710 hospitalizations for CABG across the U.S.

Conclusions:

  • A complex, U-shaped association between BMI and mortality in patients hospitalized for CABG was confirmed.
  • The findings support the existence of the "obesity paradox" in the context of coronary artery bypass grafting within a real-world setting.
  • Both underweight and extreme obesity are associated with increased mortality risk following CABG.

Keywords:
body mass index (BMI)coronary artery bypass grafting surgery (CABG)ischemic heartmortalityoutcome

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