Abstract 18702: Obesity Paradox in Women Undergoing Percutaneous Coronary Intervention With Drug-eluting Stents: Results From a Patient-level Pooled Analysis of Randomized Controlled Trials
Background: Obesity is associated with increased cardiovascular risk. Paradoxically, however, patients with higher body mass index (BMI) might have better outcomes after acute coronary syndrome treated with percutaneous coronary intervention (PCI). The effect of different BMI categories on long-term cardiac outcomes in women receiving drug-eluting stents (DES) has not been well characterized.
Methods: We pooled patient-level data for female participants from 26 randomized trials of DES in patients with coronary artery disease. Patients were stratified according to BMI category in BMI < 25 (normal weight), 25 to 30 (overweight), > 30 to 35 (obese) or > 35 (Morbidly obese). Primary endpoint was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction or target lesion revascularization. Secondary endpoint was all-cause mortality.
Results: From 11,557 women included in the pooled database, 9,420 had received DES and had BMI data available. Patients with higher BMI were significantly younger and more likely to have hypertension, hyperlipidemia and diabetes mellitus. However, they exhibited lower anatomical and procedural complexity. There were no differences in crude 3-year MACE rates across the 4 groups (14.6% vs. 12.9% vs. 14% vs. 13.2%; p = 0.34) but normal BMI group was associated with increased all-cause mortality (5.9% vs. 4.0% vs. 4.2% vs. 4.5%; p = 0.01). Following multivariable adjustment the 3-year risk of MACE progressively decreased with increase in BMI category (HR: 0.76, 95% CI: 0.61 - 0.94; HR: 0.71, 95% CI: 0.54 - 0.92; HR: 0.52, 95% CI: 0.38 - 0.73; p < 0.001; for overweight, obese and severely obese, respectively). Similarly, risk of 3-year mortality independently decreased in all BMI categories compared with normal BMI (HR: 0.41, 95% CI: 0.28 - 0.61; HR: 0.51, 95% CI: 0.32 - 0.80; HR: 0.48, 95% CI: 0.28 - 0.81; for overweight, obese and severely obese, respectively, p < 0.001).
Conclusion: Following PCI with DES, lower rather than higher BMI appears to be associated with higher risk of cardiac events and mortality. The reason for this paradoxical effect of obesity is not clear but may include unknown or unmeasured confounding variables or more aggressive therapies.
Author Disclosures: A. Ehteshami Afshar: None. G. Giustino: None. N. Dianai-Maleki: None. U. Baber: None. S. Sartori: None. M. Aquino: None. R. Saporito: None. P.G. Steg: Honoraria; Modest; Medtronic. S. Windecker: Other Research Support; Modest; Abbott, Boston Scientific, Biosensors, Cordis, and Medtronic. M.B. Leon: None. G.W. Stone: None. G.D. Dangas: None. R.V. Jeger: None. M. Morice: None. T. Kimura: None. H. Kim: None. R. Mehran: Research Grant; Modest; Medicines Company, Bristol-Myers Squibb and Sanofi -Aventis, and Lilly and Daiichi Sankyo. Consultant/Advisory Board; Modest; Abbott Vascular, AstraZeneca, Boston Scientifi c, Covidien, Janssen Pharmaceuticals, Maya Medical, Merck, Regado Biosciences, and Sanofi - Aventis. Other; Modest; Covidien, Janssen Pharmaceuticals, and Sanofi -Aventis.
- © 2015 by American Heart Association, Inc.