title: Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry.
abstract: BACKGROUND
  Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.
  
  
  METHODS
  We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥ 18.5 and <25.0 (n=5,945); overweight, BMI ≥ 25.0 and <30.0 (n=3,100); and obese, BMI ≥ 30.0 (n=635).
  
  
  RESULTS
  Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95% CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88-1.01; p=0.091).
  
  
  CONCLUSIONS
  Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.
authors: Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan.
authors: Yohei
authors: Y
authors: Numasawa
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Shun
authors: S
authors: Kohsaka
authors: University of Tokyo, Healthcare Quality Assessment, Tokyo, Japan.
authors: Hiroaki
authors: H
authors: Miyata
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Akio
authors: A
authors: Kawamura
authors: Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
authors: Shigetaka
authors: S
authors: Noma
authors: Department of Cardiology, National Hospital Organization, Saitama National Hospital, Saitama, Japan.
authors: Masahiro
authors: M
authors: Suzuki
authors: Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan.
authors: Susumu
authors: S
authors: Nakagawa
authors: Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
authors: Yukihiko
authors: Y
authors: Momiyama
authors: Department of Cardiology, Keiyu Hospital, Kanagawa, Japan.
authors: Kotaro
authors: K
authors: Naito
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Keiichi
authors: K
authors: Fukuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000209:etiology; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications; D012042:Registries; D012307:Risk Factors