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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

The impact of body mass index onshort- and long-term outcomes inpatients undergoing coronary revascularization

insights from the bypass angioplasty revascularization investigation (BARI)

Hitinder S. Gurm, MD^*, Patrick L. Whitlow, MD, FACC^*, Kevin E. Kip, PhD^,* BARI Investigators

^* Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Manuscript received August 2, 2001; revised manuscript received December 4, 2001, accepted December 14, 2001.

^* Reprint requests and correspondence: Dr. Kevin E. Kip, University of South Florida, FMHI, MHC 2605, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807, USA.
kkip{at}fmhi.usf.edu

OBJECTIVES: We sought to investigate the impact of body mass index (BMI) on short- and long-term outcomes after initial revascularization with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG).

BACKGROUND: Equivocal results exist on the impact of BMI on the risk of in-hospital complications after PTCA or CABG, and no long-term mortality data exist from a large series of revascularized patients.

METHODS: From the randomized series and observational registry of the Bypass Angioplasty Revascularization Investigation (BARI), 2,108 patients who had PTCA and 1,526 patients who had CABG were evaluated by taking their BMI at study entry. They were classified as follows: low (<20 kg/m²), normal (20 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), class I obese (30 to 34.9 kg/m²) and class II/III obese (35 kg/m²). In-hospital complications and short- and long-term mortalities were compared between levels of BMI within each mode of initial revascularization.

RESULTS: Among patients who had PTCA, each unit increase in BMI was associated with a 5.5% lower adjusted risk of a major in-hospital event (death, myocardial infarction, stroke, coma); among patients who had CABG, no difference in the in-hospital outcome was observed according to BMI. In contrast, BMI was not associated with five-year mortality in the PTCA group; among the CABG group, adjusted relative risks of five-year cardiac mortality according to levels of BMI were 0.0 (low), 1.0 (normal), 2.02 (overweight), 3.16 (class I obese) and 4.85 (class II/III obese) (linear p < 0.001).

CONCLUSIONS: Body mass index appears to have a differential impact on short- and long-term outcomes after coronary revascularization. These results underscore the need for further research to identify factors responsible for the apparent short-term protective effect of a higher BMI in patients undergoing PTCA and to study the impact of weight reduction on the long-term survival of obese patients undergoing CABG.

Abbreviations and Acronyms   BARI   BARI   Bypass Angioplasty Revascularization Investigation   BMI   body mass index   CABG   coronary artery bypass graft surgery   MI   myocardial infarction   PCI   percutaneous coronary intervention   PTCA   percutaneous transluminal coronary angioplasty

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