Impact of body mass index on the five-year outcome of patients having percutaneous coronary interventions with drug-eluting stents

Sarno, Giovanna; Räber, Lorenz; Onuma, Yoshinobu; Garg, Scot; Brugaletta, Salvatore; van Domburg, Ron T; Pilgrim, Thomas; Pfäffli, Nico; Wenaweser, Peter; Windecker, Stephan; Serruys, Patrick (2011). Impact of body mass index on the five-year outcome of patients having percutaneous coronary interventions with drug-eluting stents. American journal of cardiology, 108(2), pp. 195-201. New York, N.Y.: Elsevier 10.1016/j.amjcard.2011.03.023

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The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drug-eluting stents. Patients were stratified according to BMI as normal (<25 kg/m(2)), overweight (25 to 30 kg/m(2)), or obese (>30 kg/m(2)). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p = 0.02) and early stent thrombosis (1.5% vs 0.9%, p = 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p = 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p = 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p = 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Räber, Lorenz; Pilgrim, Thomas; Wenaweser, Peter Martin and Windecker, Stephan

ISSN:

0002-9149

Publisher:

Elsevier

Language:

English

Submitter:

Lorenz Räber

Date Deposited:

04 Oct 2013 14:21

Last Modified:

06 Mar 2014 23:33

Publisher DOI:

10.1016/j.amjcard.2011.03.023

PubMed ID:

21529741

Web of Science ID:

000294031500005

URI:

https://boris.unibe.ch/id/eprint/7227 (FactScience: 212414)

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