title: Obesity paradox in Japanese patients after percutaneous coronary intervention: an observation cohort study.
abstract: BACKGROUND
  The impact of obesity on Japanese patients who undergo primary percutaneous coronary intervention (PCI) remains unclear.
  
  
  RESULTS
  Within a single hospital-based cohort in the Shinken Database 2004-2010, which comprised all new patients (n=15227) who visited the Cardiovascular Institute, we followed patients who underwent PCI. Major adverse cardiac events (MACE)-death, myocardial infarction, or target lesion revascularization (TLR)-were defined as the composite endpoint. A total of 1205 patients were included in this study (median follow-up of 1037±703 days): 92 lean [body-mass-index (BMI)<20]; 640 normal-weight (BMI=20-24.9); 417 overweight (BMI=25-29.9); and 56 obese (BMI≥30). Mean age decreased and male gender increased with increasing BMI. Classic coronary risk factors were more common in overweight and obese patients than in normal-weight and lean patients. Chronic kidney disease (CKD) was more common in lean patients than in overweight and obese patients. Patients taking dual antiplatelet therapy, statins, beta-blockers, and renin-angiotensin-system inhibitors increased in a BMI-dependent manner. Obese patients had a significantly lower frequency of MACE, all-cause death, cardiac death, and hospital admission for heart failure than lean patients. Multivariate analysis showed that BMI category was independently associated with all-cause death after PCI.
  
  
  CONCLUSIONS
  Over-weight and obese patients were independently associated with favorable long-term clinical outcomes after PCI, suggesting that obesity paradox was applicable to Japanese patients after PCI in real-world clinical setting.
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan. h-kaneko@cvi.or.jp
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukamachi
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Funada
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000367:Age Factors; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D015331:Cohort Studies; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Japanese; Obesity; Percutaneous coronary intervention; Prognosis