title: Obesity Paradox in Off-Pump Coronary Artery Bypass Surgery: Does It Benefit the Elderly?
abstract: BACKGROUND
  The obesity paradox is a well-known phenomenon in cardiovascular disease; how it interferes with coronary artery revascularization remains controversial. The purpose of this study was to investigate the impact of obesity body mass index (BMI > 30; in kg/m2) on short- and long-term survival and major adverse cardiovascular event (MACE)-free survival in obese patients after off-pump coronary artery bypass operation.
  
  
  METHODS
  We retrospectively reviewed our prospective cohort of 1,400 consecutive and systematic patients who underwent off-pump coronary artery bypass operation between September 1996 and November 2007 and identified 448 (32%) with preoperative BMI greater than 30.
  
  
  RESULTS
  Patients with BMI greater than 30 patients were younger and had a higher prevalence of diabetes, dyslipidemia, hypertension, and percutaneous coronary interventions than patients with BMI less than 30. Thirty-day mortality and perioperative myocardial infarction were similar in both groups. No significant difference was observed for wound infections, sternal dehiscence, and reoperation for bleeding. Overall, long-term survival was comparable in the two groups, although obese patients older than 65 years had a better survival than the nonobese patients even after correction for risk factors (p = 0.04). MACE-free survival at 10 years was 65.3% ± 5.7% in obese and 76.3% ± 2.3% in nonobese patients (p = 0.007). Statistical significance was maintained (p = 0.008) after correction for risk factors. Among MACE, only new episodes of congestive heart failure were more prevalent in obese patients (p = 0.002).
  
  
  CONCLUSIONS
  In our series of off-pump coronary artery bypass operation, obesity was not an independent cause of short- and long-term mortality and was shown beneficial for older patients. However, obese patients had a lower MACE-free survival because of an increased incidence of rehospitalization for congestive heart failure.
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Badrudin
authors.affiliation: Department of Cardiovascular Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Feras
authors.initials: F
authors.lastname: Khaliel
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. Electronic address: raymond.cartier@icm-mhi.ca.
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009765:Obesity / Q000503:physiopathology*; D010359:Patient Readmission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology