The influence of body mass index on outcomes and the benefit of antiplatelet therapy following percutaneous coronary intervention.
In general, obesity is associated with better outcome in patients undergoing percutaneous coronary interventions (PCI). One small study has suggested that these patients do not achieve adequate platelet inhibition with clopidogrel and that this may shape clinical outcomes. We evaluated the relationship between body mass index (BMI) and clinical outcomes at 1 year following PCI in patients randomized to clopidogrel or placebo in the CREDO trial.


RESULTS
BMI, baseline clinical characteristics and clopidogrel regimen were assessed in 2,116 patients. The primary study endpoint was the 1-year composite of death, MI or stroke. A total of 342 patients had low or normal BMI (< 25 kg per m2), 847 were overweight (25-29.9 kg per m2), 810 were obese (30-39.9 kg per m2) and 113 were very obese (greater than or equal to 40 kg per m2). Obese patients were more likely to be young males with diabetes, hypertension and hyperlipidemia (p < 0.01). Bleeding complications occurred in 38% of low BMI, 32% of overweight/obese, and 25% of very obese patients (p = 0.03). Randomization to clopidogrel was associated with a 25% risk reduction in 1-year death, MI or stroke events, as BMI increased by every 5 kg per m2 (p = 0.009).


CONCLUSIONS
In general, increasing BMI was associated with better efficacy and bleeding outcomes at 1 year in this nonurgent PCI population. Randomization to early- and long-term clopidogrel was associated with even further improvements in those with increasing BMI.
Kelly
Robert V
RV
University of North Carolina, Chapel Hill, North Carolina, USA.
Hsu
Amy
A
Topol
Eric
E
Steinhubl
Steven
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015992:Body Mass Index; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012044:Regression Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine