title: No evidence of "obesity paradox" after treatment with drug-eluting stents in a routine clinical practice: results from the prospective multicenter German DES.DE (German Drug-Eluting Stent) Registry.
abstract: OBJECTIVE
  The aim of this study was to compare clinical outcomes among unselected patients stratified in categories of body mass index, who underwent percutaneous coronary intervention (PCI) with either sirolimus-eluting or paclitaxel-eluting stents.
  
  
  BACKGROUND
  Overweight and obesity are often considered risk factors for cardiovascular events. However, recent studies have associated obesity with better outcomes after PCI with bare-metal stents. Data from routine clinical practice using drug-eluting stents (DES) focusing on this "obesity paradox" are not available.
  
  
  METHODS
  We used data from DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and 1-year outcomes among unselected patients undergoing PCI with DES implantation. Primary endpoints were the rate of major adverse cardiac and cerebrovascular events (MACCE) (defined as the composite of death, myocardial infarction, and stroke) and target vessel revascularization (TVR).
  
  
  RESULTS
  Between October 2005 and 2006, 1,436 normal weight, 2,839 overweight, and 1,531 obese patients treated with DES were enrolled at 98 sites. Baseline clinical parameters were more severe in overweight and obese patients; 1-year follow-up comparison between groups revealed similar rates of all-cause death (3.3% vs. 2.4% vs. 2.4%; p=0.17), MACCE (7.1% vs. 5.6% vs. 5.5%; p=0.09), and TVR in survivors (10.9% vs. 11.7% vs. 11.6%; p=0.56) in normal weight individuals compared with overweight or obese patients. Such results persisted after risk-adjustment for heterogeneous baseline characteristics of groups and were independent of the types of DES.
  
  
  CONCLUSIONS
  DES.DE revealed no evidence of "obesity paradox" in a routine clinical practice using DES.
authors.affiliation: Heart Center Rostock, Department of Internal Medicine I, Division of Cardiology, University Hospital Rostock, Rostock, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Ralph
authors.initials: R
authors.lastname: Tölg
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bergmann
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D017239:Paclitaxel / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D013223:Statistics as Topic
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus