Abstract 4506: The Obesity Paradox Revisited in a Large Contemporary Database: Overweight and Obese Patient Have Better Outcomes
Background: Prior studies have shown that increased body mass index (BMI) is associated with better outcomes following elective percutaneous coronary intervention (PCI)(obesity paradox). We re-assessed these observations in a large contemporary dataset to validate these results including all clinical presentations.
Methods: Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing PCI at four New York State medical centers. Patients were divided into three groups according to BMI: normal (BMI <25), overweight (BMI 25 – 30) and obese (BMI > 30). The primary clinical endpoint was freedom from major adverse cardiac and cerebro-vascular events (MACCE) by hospital discharge.
Results: A total of 15,116 patients underwent elective, urgent and emergent PCI between 1/2004 and 12/2007. Overweight and obese patients (83.4%) were more often male, younger and had diabetes when compared to normal BMI patients. Rates of anterior wall infarction, shock and left ventricular ejection fraction were similar among the three groups. Clinical characteristics and in-hospital outcomes including MACCE (death/stroke/ infarction) rates are shown in the Table⇓.
Conclusions: Overweight and obese patients constitute the majority of patients undergoing PCI in contemporary practice. These patients have better in-hospital outcomes when compared to normal BMI patients, despite a significantly higher rate of diabetes. This difference is driven by a lower incidence of all the individual components of the primary endpoint.