The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

The obesity paradox revisited: body mass index and ­long-term outcomes after PCI from a large pooled patient-level database

EuroIntervention 2020;15:1199-1208. DOI: 10.4244/EIJ-D-19-00467

1. Institute of Cardiology, Warsaw, Poland; 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 3. Division of Cardiology, Columbia University Medical Center, New York, NY, USA; 4. Sahlgrenska University Hospital, Gothenburg, Sweden; 5. Division of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; 6. Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands;; 7. Department Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands; 8. Centre for International Cardiovascular Health, Imperial College, London, United Kingdom; 9. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Aims: The aim of this study was to evaluate the relationship between body mass index (BMI) and outcomes in patients with coronary artery disease undergoing percutaneous revascularisation.

Methods and results: In 13 randomised trials, 22,922 patients were stratified (in kg/m2) as underweight (BMI <18.5), normal weight (18.5 ≤BMI <25, used as reference), overweight (25 ≤BMI <30), and obese (Class I [30 ≤BMI <35], Class II [35 ≤BMI <40], or Class III [BMI ≥40]). The primary endpoint was all-cause death at five years. Secondary endpoints were cardiac and non-cardiac death, target (TLR) and non-target lesion revascularisation (NTLR), myocardial infarction (MI), and definite/probable stent thrombosis. Despite adjustment for multiple confounders, overweight and Class I obesity were associated with lower all-cause mortality versus normal weight (HR 0.83, 95% CI: 0.71-0.96, and HR 0.83, 95% CI: 0.69-0.96, respectively); however, non-cardiac death was the major contributor to this effect (HR 0.77, 95% CI: 0.63-0.94 for overweight). Conversely, cardiac mortality was higher in severely obese individuals (HR 1.62, 95% CI: 1.05-2.51 for Class III obesity). Obesity was associated with higher rates of NTLR (HR 1.28, 95% CI: 1.04-1.58 for Class II obesity) but not with TLR, MI and stent thrombosis.

Conclusions: Moderately increased BMI is associated with improved survival post PCI, mostly due to lower non-cardiac but not cardiac mortality.

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