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

Michela Faggioni, Usman Baber, Arash Ehteshami Afshar, Gennaro Giustino, Samantha Sartori, Sabato Sorrentino, Philippe G. Steg, Giulio G. Stefanini, Stephan Windecker, Martin B. Leon, Gregg W. Stone, William Wijns, Patrick W. Serruys, Marco Valgimigli, Edoardo Camenzind, Giora Weisz, Pieter C. Smits, David E. Kandzari, Soren Galatius, Clemens Von BirgelenRaban V. Jeger, Ghada W. Mikhail, Dipti Itchhaporia, Laxmi Mehta, Rebecca Ortega, Hyo Soo Kim, Adnan Kastrati, Alaide Chieffo, George D. Dangas, Marie-Claude Morice, Roxana Mehran*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)
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Abstract

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.

Original languageEnglish
Pages (from-to)68-76
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume11
Issue number1
DOIs
Publication statusPublished - 8 Jan 2018

Keywords

  • Clinical outcomes
  • Female patients
  • Percutaneous coronary intervention
  • Body mass index

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