Coronary artery bypass grafting outcomes in patients with different body weight

Authors: S.S. Altarev, O.L. Barbarash

Company: Research Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences; Sosnovyy
bul’var, 6, Kemerovo, 650002, Russian Federation

For citation: Altarev S.S., Barbarash O.L. Coronary artery bypass grafting outcomes in patients with different body weight. Creative Cardiology. 2014; 1: 5-15

Keywords: coronary artery bypass grafting body weight body mass index outcomes complications.

Full text:  



Objective. To determine coronary artery bypass outcomes depending on body mass index.

Material and methods. We analyzed the pooled data of the coronary artery bypass grafting (CABG) Registries which had been carried out in the Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation, in 2009 and 2011. Primary end-point included all cases of myocardial infarction, transitory ischemic attack, stroke, cardiac arrest, and death in perioperative and early postoperative periods. Primary safety end-point included all cases of re-operations for bleeding in a postoperative period.

Results. Data of 1414 patients were analyzed, of which 316 (22.3%) patients had body mass index (BMI) of less than 25.0. Primary end-point was more frequent in the patients with BMI less than 25.0 than in overweight or obese patients (7.0 vs 3.1%, respectively, p=0.002), while resternotomy rates were similar in the both groups of patients (2.8 vs 1.9%, respectively, p=0.31). After adjustment for all factors, having BMI less than 25.0 was associated with higher primary end-point risk (odds ratio (OR) 3.0, 95% contingency interval (CI) 1.4–6.5), moreover, underweight/normal weight patients tended to more frequently undergo re-operations for bleeding (OR 2.0, 95% CI 0.7–5.4). Regression analysis showed U-shaped relationships between BMI and primary end-point.

Conclusion. We showed that there was association between patients’ body weight and postoperative cerebral and cardiovascular events and death, which might be non-linear. Also, the patients with BMI less than 25.0 tended to more frequently undergo reoperations for bleeding.


1. Mangano D. Multicenter study of perioperative ischemia research group. Aspirin and mortality from coronary bypass surgery. N. Engl. J. Med. 2002; 347: 1309–17.
2. Dorner T.E., Rieder A. Obesity paradox or reverse epidemiology: is high body weight a protective factor for various chronic conditions. Dtsch. Med. Wochenschr. 2010; 135 (9); 413–8.
3. Morse S.A., Gulati R., Reisin E. The obesity paradox and cardiovascular disease. Curr. Hypertens. Rep. 2010; 12 (2): 120–6.
4. Simoons M.L., Maggioni A.P., Knatterud G., Leimberger J.D., de Jaegere P., van Domburg R. et al. Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet. 1993; 342: 1523–8.
5. Kelly R.V., Hsu A., Topol E., Steinhubl S. The influence of body mass index on outcomes and the benefit of antiplatelet therapy following percutaneous coronary intervention. J. Invasive Cardiol. 2006; 18: 115–9.
6. Tokmakoglu H. Operative and early results of coronary artery bypass grafting in female patients in different body mass indexes. J. Cardiothorac. Surg. 2010; 5: 119.
7. Criqui M.H., Klauber M.R., Barret-Conner E.L., Holdbrook M.J., Suarez L., Wingard D.L. Adjustment for obesity in studies of cardiovascular disease. Am. J. Epidemiol. 1982; 116: 685–91.
8. Gruberg L., Mercado N., Milo S., Boersma E., Disco C., van Es G.A. et al. Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II? Am. J. Cardiol. 2005; 95: 439–44.
9. Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J., Shah A. Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis. Ann. Thorac. Surg. 2005; 79: 1976–86.
10. Rahmanian P.B., Adams D.H., Castillo J.G., Chikwe J., Bodian C.A., Filsoufi F. Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both. Am. J. Cardiol. 2007; 100: 1702–8.
11. Le-Bert G., Santana O., Pineda A.M., Zamora C., Lamas G.A., Lamelas J. The obesity paradox in elderly obese patients undergoing coronary artery bypass surgery. Interact. Cardiovasc. Thorac. Surg. 2011; 13: 124–7.
12. Tyson G.H., 3rd, Rodriguez E., Elci O.C., Koutlas T.C., Chitwood W.R., Jr, Ferguson T.B. et al. Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Ann. Thorac. Surg. 2007; 84: 3–9.
13. Schwann T.A., Habib R.H., Zacharias A., Parenteau G.L., Riordan C.J., Durham S.J. et al. Effects of body size on operative, intermediate, and long term outcomes after coronary artery bypass operation. Ann. Thorac. Surg. 2001; 7: 521–30.
14. Nolan H.R., Ramaiah Ch. Effect of body mass index on postoperative transfusions and 24-hour chesttube output. Int. J. Angiol. 2011; 20: 81–6.
15. Shevde K., Pagala M., Tyagaraj C., Udeh C., Punjala M., Arora S. et al. Preoperative blood volume deficit influences blood transfusion requirements in females and males undergoing coronary bypass graft surgery. J. Clin. Anesth. 2002; 14: 512–7.
16. Sun X., Hill P.C., Bafi A.S., Garcia J.M., Haile E., Corso P.J. et al. Is cardiac surgery safe in extremely obese patients (body mass index 50 or greater)? Ann. Thorac. Surg. 2009; 87: 540–7.
17. Andersen P. Hypercoagulability and reduced fibrinolysis in hyperlipidemia: Relationship to the metabolic cardiovascular syndrome. J. Cardiovasc. Pharmacol. 1992; 20 (Suppl. 8); S29–S31.
18. Nieuwdorp M., Stroes E.S., Meijers J.C., Bьller H. Hypercoagulability in the metabolic syndrome. Curr. Opin. Pharmacol. 2005; 5: 155–9.
19. Flegal K.M., Graubard B.I., Williamson D.F., Gail M.H. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005; 293: 1861–7.
20. McGee D.L. Body mass index and mortality: a metaanalysis based on person-level data from twenty-six observational studies. Ann. Epidemiol. 2005; 15: 87–97.
21. Romero-Corral A., Montori V.M., Somers V.K., Korinek J., Thomas R.J., Allison T.G. et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006; 368: 666–78.
22. Alam M., Siddiqui S., Lee V.-V., Elayda M.A., Nambi V., Yang E.Y. et al. Isolated coronary artery bypass grafting in obese individuals – A propensity matched analysis of outcomes. Circ. J. 2011; 75: 1378–85.
23. Gurm H.S., Whitlow P.L., Kipm K.E. The impact of body mass index on short- and long-term outcomes in patients undergoing coronary revascularization: Insights from the Bypass Angioplasty Revascularization Investigation (BARI). J. Am. Coll. Cardiol. 2002; 39: 834–40.
24. Sung Sh.-H., Wu T.-Ch., Huang Ch.-H., Lin Sh.-J., Chen J.-W. Prognostic impact of body mass index in patients undergoing coronary artery bypass surgery. Heart. 2011; 97: 648–54.
25. Engel A.M., McDonough S., Smith J.M. Does an obese body mass index affect hospital outcomes after coronary artery bypass graft surgery? Ann. Thorac. Surg. 2009; 88: 1793–800.
26. Perrotta S., Nilsson F., Brandrup-Wognsen G., Jeppsson A. Body mass index and outcome after coronary artery bypass surgery. J. Cardiovasc. Surg. (Torino). 2007; 48 (2): 239–45.
27. Potapov E.V., Loebe M., Anker S., Stein J., Bondy S., Nasseri B.A. et al. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. Eur. Heart J. 2003; 24: 1933–41.
28. Wagner B.D., Grunwald G.K., Rumsfeld J.S., Hill J.O., Ho P.M., Wyatt H.R. et al. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Ann. Thorac. Surg. 2007; 84: 10–6.
29. Bucholz E.M., Rathore S.S., Reid K.J., Jones P.G., Chan P.S., Rich M.W. et al. Body mass index and mortality in acute myocardial infarction patients. Am. J. Med. 2012; 125 (8): 796–803.
30. Kastorini C.M., Panagiotakos D.B. The obesity paradox: Methodological considerations based on epidemiological and clinical evidence – New insights. Maturitas. 2012; 72 (3): 220–4.
31. Von Haehling S., Lainscak M., Springer J., Anker S.D. Cardiac cachexia: a systematic overview. Pharmacol. Ther. 2009; 121 (3): 227–352.
32. Kovacic J.C., Lee P., Baber U., Karajgikar R., Evrard S.M., Moreno P. et al. Inverse relationship between body mass index and coronary artery calcification in patients with clinically significant coronary lesions. Atherosclerosis. 2012; 221 (1): 176–82.
33. Yusuf S., Hawken S., Фunpuu S., Bautista L., Franzosi M.G., Commerford P. et al. Obesity and the risk of myocardial infarciton in 27 000 participants from 52 countries: a case-control study. Lancet. 2005; 366: 1640–9.
34. Filardo G., Hamilton C., Hamman B., Ng H.K., Grayburn P. Categorizing BMI may lead to biased results in studies investigating in-hospital mortality after isolated CABG. J. Clin. Epidemiol. 2007; 60 (11): 1132–9.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery