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Original article
Prognostic impact of body mass index in patients undergoing coronary artery bypass surgery
  1. Shih-Hsien Sung1,
  2. Tao-Cheng Wu1,
  3. Cheng-Hsiung Huang2,
  4. Shing-Jong Lin1,3,4,5,
  5. Jaw-Wen Chen1,3,4,6
  1. 1Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
  2. 2Division of Cardiovascular Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
  3. 3Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
  4. 4Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
  5. 5Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
  6. 6Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
  1. Correspondence to Jaw-Wen Chen, Department of Medical Research and Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan, ROC; jwchen{at}


Background Obesity has numerous adverse effects on general, and especially, cardiovascular health. Plasma adiponectin, an adipokine, is inversely related to adipose tissue mass, and also the prognosis of heart failure and coronary artery disease (CAD). Coronary artery bypass grafting (CABG) surgery is usually the treatment of choice for patients with complex CAD.

Objective To investigate the impact of body mass index (BMI) and the associated biomarkers on clinical outcomes after CABG.

Methods Patients with CAD who underwent CABG by a single cardiac surgeon team were prospectively enrolled and followed for up to 5 years after CABG.

Results Among the 234 consecutive patients (aged 70.4±10.5 years, BMI 24.68±3.27 kg/m2, 84.6% men), there were 76 mortalities during follow-up. BMI was negatively correlated with adiponectin (r=−0.203, p=0.003), high-sensitivity C-reactive protein (hsCRP; r=−0.176, p=0.009), and N-terminal pro-brain natriuretic peptide (NT-proBNP; r=−0.271, p<0.001). Patients of normal weight (BMI <25 kg/m2) had a decreased event free survival when compared with overweight or obese patients (BMI ≥25 kg/m2). After accounting for age, sex, manifest acute coronary syndrome, glomerular filtration rate, and left ventricular ejection fraction, BMI remained correlated with cardiovascular mortality in the study population. (HR and 95% CI per 1 kg/m2: 0.912 (0.833 to 0.998)). However, adiponectin, hsCRP, and NT-proBNP would abolish the prognostic impact of BMI. In addition, risk-stratified subgroup analysis showed that adiponectin, hsCRP and NT-proBNP predicted mortality in patients with normal weight, rather than in overweight or obese patients.

Conclusions BMI was inversely associated with the prognosis of CABG. Such association may be linked to the baseline mechanisms related to metabolic disorder (adiponectin) and systemic inflammation (hsCRP). Future pathophysiological validation is indicated.

  • Adiponectin
  • body mass index
  • coronary artery bypass surgery
  • obesity paradox
  • prognosis
  • surgery-coronary bypass
  • obesity
  • coronary artery disease (CAD)

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  • Funding This study was partially supported by grants from National Science Council, Taiwan, ROC (95-2314-B-010-024-MY3 to J-WC), and from Taipei Veterans General Hospital, Taiwan, ROC (V95C1-095, V97ER2-003, VN 9803 and V98C1-012 to J-WC).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Taipei Veterans General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.