The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice.
OBJECTIVE
We analyzed the relationship of obesity, determined by body mass index (BMI), to short- and long-term outcomes in the TARGET trial.


BACKGROUND
: Previous studies have conflicting findings regarding the relationship of BMI to outcomes following percutaneous coronary intervention (PCI).


METHODS
The TARGET trial studied the use of glycoprotein (GP) IIb/IIIa inhibition in patients undergoing planned coronary stent placement.


RESULTS
Eighty-one percent of all patients were overweight (BMI > 25), 36% were obese (BMI > 30), and United States patients were more frequently obese (38.7% vs. 25.8%, P < 0.001). Obese patients had a similar 30-day ischemic event rate compared with nonobese patients, but less major bleeding (0.4% vs. 1.1%, P = 0.013). Six-month death and myocardial infarction rates were similar in obese and nonobese patients. There was a J-shaped relationship between 6-month target vessel revascularization (TVR) and BMI with the lowest incidence of TVR at BMI 27.5. Six-month TVR was higher in the morbidly (BMI > 35) obese (12.4% vs 8.7%, P < 0.05). In extremely (BMI > 32) obese patients, this relationship was more significant (TVR 11.3% vs. 8.5%, P = 0.007), particularly in patients <65 years of age (TVR 12.3% vs. 8.4%, P = 0.003).


CONCLUSIONS
The majority of patients undergoing PCI are overweight, especially in the United States. Extreme obesity is associated with a significant increase in TVR following intent-to-stent PCI, especially in patients <65 years of age. With routine use of GP IIb/IIIa inhibitors, other long- and short-term ischemic events are similar in obese and nonobese patients. However, obese patients have significantly less major bleeding.
Main Line Health, Sharpe-Strumia Research Foundation of the Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, USA. martinj@mlhs.org
Jack L
JL
Martin
Gang
G
Jia
Seth S
SS
Martin
Timothy A
TA
Shapiro
Howard C
HC
Herrmann
Peter M
PM
Dibattiste
Eric J
EJ
Topol
David J
DJ
Moliterno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015607:Stents; D016896:Treatment Outcome
D000925:Anticoagulants; D008670:Metals; D019039:Platelet Glycoprotein GPIIb-IIIa Complex