Impact of Metabolic Obesity Phenotype on Long-term Prognosis after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

doi:10.12114/j.issn.1007-9572.2025.0339

Abstract

Abstract:

Background

Obesity is a major risk factor for cardiovascular disease, but evidence regarding the impact of metabolic obesity phenotypes on the prognosis of acute coronary syndrome (ACS) remains insufficient.

Objective

Exploring the impact of diverse metabolic obesity phenotypes on the pognosis of prcutaneous coronary intervention (PCI) in ACS patients.

Methods

This study employed a prospective cohort design, consecutively enrolling patients who presented with chest pain at the First Affiliated Hospital of Xinjiang Medical University between June 2012 and June 2023, were diagnosed with ACS, and underwent PCI within 12 hours of symptom onset. Baseline data collected included general demographic characteristics, anthropometric measurements, laboratory test results, imaging findings, and procedural details. Participants were categorized into four groups based on the presence of obesity and metabolic syndrome: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). All patients underwent follow-up via telephone and/or outpatient visits every 12 months post-procedure to record major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, stroke, rehospitalization for unstable angina, and heart failure recurrence. Kaplan-Meier survival curves were used to analyze MACCE incidence across the four groups, with log-rank tests for comparisons. Multivariate Cox proportional hazards regression models were employed to assess the association between metabolic obesity phenotypes and MACCE risk.

Results

A total of 1 913 ACS patients were included in this study, with an average age of (58.8±12.1) years. Among them, there were 1 588 males (83.0%) and 325 females (17.0%).There were 612 cases in the MHNW group, 878 cases in the MUNW group, 105 cases in the MHO group, and 318 cases in the MUO group. There were statistically significant differences in the comparison of age, gender, BMI, the prevalence of hypertension diabetes, and proportion of smoking, admission systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood glucose, hemoglobin concentration, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, urea, uric acid, and direct bilirubin levels among the 4 groups (P<0.05). Median follow-up time was 4.77 (2.26, 7.16) years, with 136 patients (7.1%) lost to follow-up. A total of 656 cases (34.3%) of MACCE occurred. There were statistically significant differences in the incidence of MACCE and the incidence of readmission for unstable angina pectoris between the 4 groups (P<0.05). Kaplan-Meier survival curve analysis showed that the difference in Cumulative risk probability of MACCE among the four groups was statistically significant (χ²=26.23, P<0.001). Multivariate Cox regression analysis showed that after adjustment for age, sex, smoking, SBP, DBP, TG, HDL-C, LDL-C, urea, and uric acid, the risks of MACCE in the MHO, MUNW, and MUO groups were 1.56, 1.28, and 1.94 times that of the MHNW group, respectively (P<0.05). The results of the sensitivity analysis demonstrated the stability of the association between metabolically obese phenotypes and the risk of developing MACCE in the prognosis.

Conclusion

Obesity significantly increases the risk of long-term adverse outcomes in patients with ACS undergoing PCI regardless of metabolic status, and the risk is even higher in those with concurrent metabolic abnormalities. Clinical management should emphasize the long-term adverse effects of obesity, and stratified evaluation and individualized intervention should be performed in combination with metabolic status.

Key words: Acute coronary syndrome, Metabolism, Obesity, Disease prognosis, Cohort study

摘要：

背景

肥胖是心血管疾病的重要危险因素，但代谢肥胖表型对急性冠脉综合征（ACS）预后影响的证据仍不充足。

目的

探讨不同代谢肥胖表型对ACS患者经皮冠状动脉介入治疗预后的影响。

方法

采用前瞻性队列研究设计，连续纳入2012年6月—2023年6月因胸痛就诊于新疆医科大学第一附属医院，诊断为ACS且在胸痛发作12 h内接受经皮冠状动脉介入治疗的患者为研究对象，收集患者的基线资料。根据研究对象是否肥胖和代谢状态分为代谢健康非肥胖（MHNW）组、代谢健康肥胖（MHO）组、代谢不健康非肥胖（MUNW）组和代谢不健康肥胖（MUO）组。术后所有患者每12个月接受1次电话和/或门诊随访，记录并收集患者发生的主要不良心脑血管事件（MACCE）。采用Kaplan-Meier生存曲线及Log-rank检验比较4组人群MACCE的发生率，利用多因素Cox比例风险回归模型分析不同代谢肥胖表型与MACCE的关系。

结果

本研究共纳入1 913例ACS患者，平均年龄（58.8±12.1）岁，其中男1 588例（83.0%），女325例（17.0%）。MHNW组612例，MUNW组878例，MHO组105例，MUO组318例。4组年龄、性别、BMI、高血压比例、糖尿病比例、吸烟比例、入院收缩压（SBP）和舒张压（DBP）、血糖、血红蛋白浓度、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、肌酐、尿素、尿酸、直接胆红素水平比较，差异均有统计学意义（P<0.05）。中位随访时间4.77（2.26，7.16）年，136例（7.1%）失访，共发生656例（34.3%）MACCE。4组MACCE发生率和不稳定型心绞痛再入院发生率比较，差异均有统计学意义（P<0.05）。Kaplan-Meier生存曲线分析结果显示，4组MACCE累积风险概率比较，差异有统计学意义（χ²=26.23，P<0.001）。多因素Cox回归分析结果表明，调整年龄、性别、吸烟、SBP、DBP、TG、LDL-C、HDL-C、尿素和尿酸等变量因素后，MHO组、MUNW组、MUO组发生MACCE的风险分别为MHNW组的1.56、1.28、1.94倍（P<0.05）。敏感性分析结果证明了代谢肥胖表型与预后MACCE发生风险关联的稳定性。

结论

无论代谢状态如何肥胖均显著增加了ACS患者经皮冠状动脉介入治疗的远期不良预后风险，而合并代谢异常者风险更高。临床管理应重视肥胖的长期不利影响，并结合代谢状态进行分层评估与个体化干预。

关键词: 急性冠状动脉综合征, 代谢, 肥胖, 疾病预后, 队列研究

CLC Number:

R 542.2 R 589.25

HAN Congcong,QIU Xinyu,SHAN Chunfang, et al. Impact of Metabolic Obesity Phenotype on Long-term Prognosis after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome[J]. Chinese General Practice, 2026, 29(21): 2950-2958. DOI: 10.12114/j.issn.1007-9572.2025.0339.
韩聪聪,邱欣雨,单春方等. 代谢肥胖表型对急性冠脉综合征患者经皮冠状动脉介入治疗远期预后的影响研究[J]. 中国全科医学, 2026, 29(21): 2950-2958. DOI: 10.12114/j.issn.1007-9572.2025.0339.

Figures/Tables 6

References 40

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项目	MHNW（n=612）	MHO（n=105）	MUNW（n=878）	MUO（n=318）	检验统计量值	P值
年龄（±s，岁）	59.6±12.1	54.9±12.0	60.4±11.9	54.3±11.5	24.69	<0.001
性别[例（%）]					25.88^a	<0.001
男	537（87.7）	92（87.6）	688（78.4）	271（85.2）
女	75（12.3）	13（12.4）	190（21.6）	47（14.8）
BMI（±s，kg/m²）	23.9±2.4	30.7±3.1	24.6±2.1	30.7±3.0	759.96	<0.001
高血压[例（%）]	128（20.9）	20（19.0）	599（68.2）	215（67.6）	403.35^a	<0.001
糖尿病[例（%）]	33（5.4）	2（1.9）	389（44.3）	125（39.3）	321.30^a	<0.001
吸烟[例（%）]	334（54.6）	60（57.1）	406（46.2）	179（56.3）	16.21^a	0.001
饮酒[例（%）]	209（34.2）	38（36.2）	272（31.0）	109（34.3）	2.69^a	0.442
入院心率（±s，次/min）	82.2±38.7	84.3±16.2	83.2±24.8	87.2±56.9	1.41	0.238
入院SBP（±s，mmHg）	122±19	128±20	126±21	128±21	10.22	<0.001
入院DBP（±s，mmHg）	76±13	81±13	77±13	80±14	7.58	<0.001
血糖（±s，mmol/L）	6.6±2.8	6.6±2.2	8.1±3.8	8.0±4.0	28.03	<0.001
白细胞计数（±s，10⁹/L）	10.2±3.5	10.5±3.5	10.1±3.4	10.4±3.5	0.77	0.511
血红蛋白浓度（±s，g/L）	146.8±16.3	152.8±15.6	145.2±18.8	151.9±15.8	15.51	<0.001
TC（±s，mmol/L）	4.6±1.1	4.6±1.0	4.5±1.2	4.7±1.2	1.46	0.223
TG[M（P₂₅，P₇₅），mmol/L]	1.2（0.9,1.7）	1.4（1.0,1.7）	2.0（1.3,2.9）	2.4（1.6,3.4）	345.31^b	<0.001
HDL-C（±s，mmol/L）	1.1±0.3	1.0±0.3	0.9±0.2	0.9±0.2	126.00	<0.001
LDL-C（±s，mmol/L）	3.0±1.0	3.1±0.8	2.8±1.0	2.9±1.0	8.61	<0.001
肌酐（±s，mmol/L）	75.0±22.2	73.9±20.7	83.4±62.0	79.2±38.9	4.38	0.004
尿素（±s，mmol/L）	5.7±2.0	5.2±1.4	6.1±2.7	5.8±2.2	6.74	<0.001
尿酸（±s，mmol/L）	333.7±92.3	371.1±100.0	343.1±97.1	367.5±102.6	11.14	<0.001
总胆红素（±s，mmol/L）	14.6±6.6	15.4±7.1	14.3±7.0	14.9±7.8	1.30	0.272
直接胆红素（±s，mmol/L）	1.9±1.9	2.3±2.3	1.7±2.1	1.6±2.2	3.87	0.009
左心室射血分数（±s，%）	57.7±6.8	57.3±6.8	57.9±7.0	57.2±6.6	3.80	0.284

项目	MHNW（n=612）	MHO（n=105）	MUNW（n=878）	MUO（n=318）	检验统计量值	P值
年龄（±s，岁）	59.6±12.1	54.9±12.0	60.4±11.9	54.3±11.5	24.69	<0.001
性别[例（%）]					25.88^a	<0.001
男	537（87.7）	92（87.6）	688（78.4）	271（85.2）
女	75（12.3）	13（12.4）	190（21.6）	47（14.8）
BMI（±s，kg/m²）	23.9±2.4	30.7±3.1	24.6±2.1	30.7±3.0	759.96	<0.001
高血压[例（%）]	128（20.9）	20（19.0）	599（68.2）	215（67.6）	403.35^a	<0.001
糖尿病[例（%）]	33（5.4）	2（1.9）	389（44.3）	125（39.3）	321.30^a	<0.001
吸烟[例（%）]	334（54.6）	60（57.1）	406（46.2）	179（56.3）	16.21^a	0.001
饮酒[例（%）]	209（34.2）	38（36.2）	272（31.0）	109（34.3）	2.69^a	0.442
入院心率（±s，次/min）	82.2±38.7	84.3±16.2	83.2±24.8	87.2±56.9	1.41	0.238
入院SBP（±s，mmHg）	122±19	128±20	126±21	128±21	10.22	<0.001
入院DBP（±s，mmHg）	76±13	81±13	77±13	80±14	7.58	<0.001
血糖（±s，mmol/L）	6.6±2.8	6.6±2.2	8.1±3.8	8.0±4.0	28.03	<0.001
白细胞计数（±s，10⁹/L）	10.2±3.5	10.5±3.5	10.1±3.4	10.4±3.5	0.77	0.511
血红蛋白浓度（±s，g/L）	146.8±16.3	152.8±15.6	145.2±18.8	151.9±15.8	15.51	<0.001
TC（±s，mmol/L）	4.6±1.1	4.6±1.0	4.5±1.2	4.7±1.2	1.46	0.223
TG[M（P₂₅，P₇₅），mmol/L]	1.2（0.9,1.7）	1.4（1.0,1.7）	2.0（1.3,2.9）	2.4（1.6,3.4）	345.31^b	<0.001
HDL-C（±s，mmol/L）	1.1±0.3	1.0±0.3	0.9±0.2	0.9±0.2	126.00	<0.001
LDL-C（±s，mmol/L）	3.0±1.0	3.1±0.8	2.8±1.0	2.9±1.0	8.61	<0.001
肌酐（±s，mmol/L）	75.0±22.2	73.9±20.7	83.4±62.0	79.2±38.9	4.38	0.004
尿素（±s，mmol/L）	5.7±2.0	5.2±1.4	6.1±2.7	5.8±2.2	6.74	<0.001
尿酸（±s，mmol/L）	333.7±92.3	371.1±100.0	343.1±97.1	367.5±102.6	11.14	<0.001
总胆红素（±s，mmol/L）	14.6±6.6	15.4±7.1	14.3±7.0	14.9±7.8	1.30	0.272
直接胆红素（±s，mmol/L）	1.9±1.9	2.3±2.3	1.7±2.1	1.6±2.2	3.87	0.009
左心室射血分数（±s，%）	57.7±6.8	57.3±6.8	57.9±7.0	57.2±6.6	3.80	0.284

MACCE类型	MHNW（n=612）	MHO（n=105）	MUNW（n=878）	MUO（n=318）	χ²值	P值
不稳定型心绞痛再入院	91（14.9）	19（18.1）	164（18.7）	71（22.3）^a	8.36	0.039
心力衰竭再入院	30（4.9）	9（8.6）	45（5.1）	25（7.9）	5.64	0.130
全因死亡	29（4.7）	3（2.9）	47（5.4）	11（3.5）	2.72	0.436
脑卒中	11（1.8）	5（4.8）	30（3.4）	12（3.8）	5.28	0.152
非致死性心肌梗死	13（2.1）	4（3.8）	23（2.6）	14（4.4）	4.49	0.213
合计	174（28.4）	40（38.1）^a	309（35.2）^a	133（41.8）^ab	18.33	<0.001

MACCE类型	MHNW（n=612）	MHO（n=105）	MUNW（n=878）	MUO（n=318）	χ²值	P值
不稳定型心绞痛再入院	91（14.9）	19（18.1）	164（18.7）	71（22.3）^a	8.36	0.039
心力衰竭再入院	30（4.9）	9（8.6）	45（5.1）	25（7.9）	5.64	0.130
全因死亡	29（4.7）	3（2.9）	47（5.4）	11（3.5）	2.72	0.436
脑卒中	11（1.8）	5（4.8）	30（3.4）	12（3.8）	5.28	0.152
非致死性心肌梗死	13（2.1）	4（3.8）	23（2.6）	14（4.4）	4.49	0.213
合计	174（28.4）	40（38.1）^a	309（35.2）^a	133（41.8）^ab	18.33	<0.001

变量	模型1		模型2		模型3
变量	HR（95%CI）	P值	HR（95%CI）	P值	HR（95%CI）	P值
MHNW组（参照组）	1.00		1.00		1.00
MHO组	1.43（1.01~2.02）	0.042	1.56（1.10~2.20）	0.012	1.56（1.10~2.21）	0.013
MUNW组	1.33（1.10~1.60）	0.003	1.32（1.10~1.59）	0.003	1.28（1.04~1.58）	0.020
MUO组	1.79（1.42~2.24）	<0.001	2.00（1.59~2.52）	<0.001	1.94（1.51~2.50）	<0.001