Lean body mass index prognostic value for cardiovascular events in patients with coronary artery disease.
OBJECTIVE
Little is known about the relationship between body composition indicators, including body mass index (BMI), fat mass index (FMI) and lean BMI (LBMI), and adverse outcomes after percutaneous coronary intervention (PCI) in Asian populations. The aim of this study was to clarify this relationship.


METHODS
The SHINANO registry is a prospective, observational, multicenter cohort registry that enrolled 1923 consecutive patients with coronary heart disease (CHD) from August 2012 to July 2013; 66 patients were excluded because of missing data. We evaluated 1857 patients with CHD who underwent PCI (aged 70±11 years; 23% women; BMI 23.8±3.5 kg/m2; LBMI 18.3±1.8 kg/m2; FMI 5.4±2.2 kg/m2). Patients were divided into three groups, based on BMI, LBMI and FMI tertiles, to assess the prognostic value of the three indicators. The primary endpoint was major adverse cardiac events (MACE), including all cause death, non-fatal myocardial infarction and ischaemic stroke at 1 year.


RESULTS
Over a 1 year follow-up period (1776 patients, 95.6%), the cumulative MACE incidence was 8.7% (161 cases). Using Kaplan-Meier analysis, the MACE incidence was significantly higher in patients with lower BMI values (13.4-22.2 kg/m2) (p=0.002) and lower LBMI values (11.6-17.6 kg/m2) (p<0.001); this trend was not observed for FMI. Multivariate Cox regression analysis showed that lower LBMI but not lower BMI values were predictive of a higher MACE incidence (HR 1.55; 95% CI 1.05 to 2.30).


CONCLUSIONS
Lower LBMI values are associated with adverse outcomes in an Asian population with CHD undergoing PCI. LBMI is a better predictor of MACE than BMI or FMI.


BACKGROUND
UMIN-ID; 000010070.
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Hirofumi
H
Hioki
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Takashi
T
Miura
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Hirohiko
H
Motoki
Department of Cardiology , Nagano Red Cross Hospital , Nagano , Japan.
Hideki
H
Kobayashi
Department of Cardiology , Matsumoto Kyoritsu Hospital , Matsumoto , Japan.
Masanori
M
Kobayashi
Department of Cardiology , Nagano Matsushiro General Hospital , Nagano , Japan.
Hiroyuki
H
Nakajima
Department of Cardiology , Saku Central Hospital , Saku , Japan.
Hikaru
H
Kimura
Department of Cardiology , Saku Central Hospital , Saku , Japan.
Eiichiro
E
Mawatari
Department of Cardiology , Iida Municipal Hospital , Iida , Japan.
Hiroshi
H
Akanuma
Department of Cardiology , Shinonoi General Hospital , Nagano , Japan.
Toshio
T
Sato
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Souichirou
S
Ebisawa
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Yusuke
Y
Miyashita
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Uichi
U
Ikeda
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Shoji
S
Hotta
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Yuichi
Y
Kamiyoshi
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Takuya
T
Maruyama
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Noboru
N
Watanabe
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Takayuki
T
Eisawa
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Shinichi
S
Aso
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Shinichirou
S
Uchikawa
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Naoto
N
Hashizume
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Noriyuki
N
Sekimura
Department of Cardiovascular Medicine , Shinshu University School of Medicine , Matsumoto , Japan.
Takehiro
T
Morita
CORONARY ARTERY DISEASE