Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data. (October 2018) - Kim, Byung Gyu
Abstract: Background and aims: It is unclear whether the obesity paradox is still apparent in the new-generation drug-eluting stent (DES) era. Therefore, we assessed the impact of body mass index (BMI) on clinical outcome after percutaneous coronary intervention (PCI) with new-generation DESs. Methods: A total of 5264 consecutive patients from 4 new-generation DES registries were divided into 4 categories according to BMI: 1) underweight (BMI<18.5 kg/m 2, n = 130), 2) normal weight (18.5 ≤ BMI <25 kg/m 2, n = 2943), 3) overweight (25 ≤ BMI<30 kg/m 2, n = 1932), and 4) obese (BMI≥30 kg/m 2, n = 259). The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular event (MACCE) at 12 months, including all-cause mortality, nonfatal myocardial infarction, stroke, and target-vessel revascularization. Results: The 12-month MACCE rates decreased according to increasing BMI categories. (underweight, 13.1%; normal, 6.0%; overweight, 4.8%; obese, 4.2%; p < 0.001). After adjustment for other confounders, the underweight group had significantly higher MACCE rates than the normal-weight (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.33–0.99; p = 0.049), overweight (HR, 0.49; 95% CI, 0.27–0.88; p = 0.017), and obese (HR, 0.41; 95% CI, 0.18–0.98; p = 0.044) groups. These differences were mainly driven by all-cause mortality and target-vessel revascularization. When BMI was treated as a continuous variable, BMI per 1 kg/m 2 was also an independent predictor for MACCE (HR, 0.95; 95% CI, 0.91–0.99; p = 0.008) and a MACE increase began below a BMI of 24 kg/m 2 . Conclusions: Lower BMI was significantly associated with higher rates of MACCE and all-cause mortality after PCI. The obesity paradox is manifested in Korean patients in the new-generation DES era. Highlights: Lower BMI was linked to worse outcomes after new-generation DES implantation. This result was driven by not only mortality but also ischemic adverse events. A BMI below 24 kg/m 2 was an independent predictor of MACCEs. Patients with low BMI might have more atherosclerotic burden than those with high BMI. Physicians should identify other risk factors and comorbidities in patients with low BMI.