Effects of Body Mass Index on Clinical Outcomes in Female Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: Results From a Patient-Level Pooled Analysis of Randomized Controlled Trials.

Faggioni, Michela; Baber, Usman; Afshar, Arash Ehteshami; Giustino, Gennaro; Sartori, Samantha; Sorrentino, Sabato; Steg, Philippe G; Stefanini, Giulio G; Windecker, Stephan; Leon, Martin B; Stone, Gregg W; Wijns, William; Serruys, Patrick W; Valgimigli, Marco; Camenzind, Edoardo; Weisz, Giora; Smits, Pieter C; Kandzari, David E; Galatius, Soren; Von Birgelen, Clemens; ... (2018). Effects of Body Mass Index on Clinical Outcomes in Female Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: Results From a Patient-Level Pooled Analysis of Randomized Controlled Trials. JACC. Cardiovascular Interventions, 11(1), pp. 68-76. Elsevier 10.1016/j.jcin.2017.06.060

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OBJECTIVES This study sought to investigate the effect of different body mass index (BMI) categories on clinical outcomes in female patients treated with percutaneous coronary intervention (PCI) and drug-eluting stents. BACKGROUND Patients with higher BMI might, paradoxically, have better long-term clinical outcomes after acute coronary syndrome treated with PCI. METHODS We pooled patient-level data for female participants from 26 randomized trials on PCI with drug-eluting stents. Patients were stratified into underweight (BMI, <18.5), normoweight (BMI, 18.5 to 24.9), overweight (BMI, 25 to 29.9), obese (BMI, 30 to 34.9), or morbidly obese (BMI, ≥35). The primary endpoint was major adverse cardiac events, a composite of death, myocardial infarction, or target lesion revascularization at 3 years. RESULTS Among 11,557 female patients included in the pooled database, 9,420 were treated with a drug-eluting stent and had BMI data available. Patients with higher BMI were significantly younger and with more cardiovascular risk factors. Only 139 patients were underweight and had significantly higher adjusted rates of cardiac mortality and all-cause mortality than the rest of the population (hazard ratio: 2.20 [1.31 to 3.71] compared with normoweight). There was a significantly lower frequency of unadjusted 3-year all-cause mortality in overweight, obese, and severely obese patients compared with normoweight. However, following multivariable analysis, a trend toward increased risk of death in severely obese patients was observed, describing an inverse "J"-shaped relation between BMI and 3-year mortality. Conversely, the relationship between BMI and other outcomes, such as major adverse cardiac events, was flat for normoweight and higher BMI. CONCLUSIONS The risk of 3-year adjusted cardiac events did not differ across BMI groups, whereas the risk of all-cause mortality compared with normoweight was significantly higher in underweight patients and lower in overweight patients with a trend toward increased risk in the severely obese population.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

16 Apr 2018 12:42

Last Modified:

11 Nov 2019 19:48

Publisher DOI:

10.1016/j.jcin.2017.06.060

PubMed ID:

29248412

Uncontrolled Keywords:

body mass index clinical outcomes female patients percutaneous coronary intervention

BORIS DOI:

10.7892/boris.111053

URI:

https://boris.unibe.ch/id/eprint/111053

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