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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

The impact of obesity on the short-term andlong-term outcomes after percutaneous coronary intervention: the obesity paradox?

^* Cardiac Catheterization Laboratory and the Cardiovascular Research Institute, Washington Hospital Center, Washington, D.C., USA

Manuscript received March 9, 2001; revised manuscript received November 7, 2001, accepted November 28, 2001.

^* Reprint requests and correspondence: Dr. Luis Gruberg, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street, Northwest, Suite 4B-1, Washington, DC 20010, USA.
gruberg67{at}hotmail.com

OBJECTIVES: The purpose of this study was to assess the impact of body mass index (BMI) on the short- and long-term outcomes after percutaneous coronary intervention (PCI).

BACKGROUND: Obesity is associated with advanced coronary artery disease (CAD). However, the relation between BMI and outcome after PCI remains controversial.

METHODS: We studied 9,633 consecutive patients who underwent PCI between January 1994 and December 1999. Patients were divided into three groups according to BMI: normal, BMI between 18.5 and 24.9 (n = 1,923); overweight, BMI between 25 and 30 (n = 4,813); and obese, BMI >30 (n = 2,897).

RESULTS: Obese patients were significantly younger and had consistently worse baseline clinical characteristics than normal or overweight patients, with a higher incidence of hypertension, diabetes, hypercholesterolemia and smoking history (p < 0.0001). Despite similar angiographic success rates among the three groups, normal BMI patients had a higher incidence of major in-hospital complications, including cardiac death (p = 0.001). At one-year follow-up, overall mortality rates were significantly higher for normal BMI patients compared with overweight or obese patients (p < 0.0001). Myocardial infarction and revascularization rates did not differ among the three groups. By multivariate Cox regression analysis, diabetes, hypertension, age, BMI and left ventricular function were independent predictors of long-term mortality.

CONCLUSIONS: In patients with known CAD who undergo PCI, very lean patients (BMI <18.5) and those with BMI within the normal range are at the highest risk for in-hospital complications and cardiac death and for increased one-year mortality.

Abbreviations and Acronyms   LVEF   BMI   body mass index   CI   confidence interval   LVEF   left ventricular ejection fraction   MI   myocardial infarction   OR   odds ratio   PCI   percutaneous coronary intervention

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