title: Impact of body mass index on the five-year outcome of patients having percutaneous coronary interventions with drug-eluting stents.
abstract: The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drug-eluting stents. Patients were stratified according to BMI as normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p = 0.02) and early stent thrombosis (1.5% vs 0.9%, p = 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p = 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p = 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p = 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia.
authors.affiliation: Department of Interventional Cardiology, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Nico
authors.initials: N
authors.lastname: Pfäffli
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
mesh_terms: D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D013557:Switzerland / Q000453:epidemiology