title: Effect of obesity on coronary atherosclerosis and outcomes of percutaneous coronary intervention: grayscale and virtual histology intravascular ultrasound substudy of assessment of dual antiplatelet therapy with drug-eluting stents.
abstract: BACKGROUND
  Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood.
  
  
  RESULTS
  Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts.
  
  
  CONCLUSIONS
  A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rinaldi
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Peter L
authors.initials: PL
authors.lastname: Duffy
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Takehisa
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.).
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.). amaehara@crf.org.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D015992:Body Mass Index; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel
keywords: atherosclerosis; obesity