Abstract
Studies that have tested the relationship between body weight as assessed by body mass index (BMI) and clinical outcome after percutaneous coronary intervention (PCI) have given contradictory results. The aim of the study was to investigate the impact of BMI on clinical outcome and assess the impact of adjustment for other cardiovascular risk factors on the relationship between obesity and clinical outcome in patients with acute coronary syndromes (ACS) following PCI. This study included 9146 patients with ACS who underwent coronary angiography and PCI: 2610 patients with ST-segment elevation acute myocardial infarction, 2792 patients with non-ST-segment elevation acute myocardial infarction, and 3744 patients with unstable angina. The primary outcome of this analysis was 1-year mortality. Quartiles of BMI were: 12.8 to <24.3 (1st quartile), 24.3 to <26.4 (2nd quartile), 26.4 to <29.1 (3rd quartile), and >29.1 to 50.7 (4th quartile). Within the first year following PCI, there were 756 deaths: 228 deaths in the 1st BMI quartile, 209 deaths in the 2nd BMI quartile, 161 deaths in the 3rd BMI quartile and 158 deaths in the 4th BMI quartile (Kaplan-Meier estimates of mortality 10.3%, 9.1%, 7.2%, and 7.0%, respectively; odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.22-1.86, P < 0.001 for 1st vs 4th BMI quartile). After adjustment in the Cox proportional hazards model, the association between BMI and 1-year mortality was attenuated to the level of statistical insignificance (hazards ratio [HR] = 1.25, 95% CI 0.94–1.64; P = 0.127 for 1st vs 4th BMI quartile). In conclusion, in patients with ACS undergoing PCI, obesity as assessed with BMI was not an independent correlate of 1-year mortality.
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Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555
Reuser M, Bonneux L, Willekens F (2008) The burden of mortality of obesity at middle and old age is small A life table analysis of the US Health and Retirement Survey. Eur J Epidemiol 23:601–607
Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O’Donnell C, Roger V, Sorlie P, Steinberger J, Thom T, Wilson M, Hong Y (2008) Heart Disease and Stroke Statistics 2008 Update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117:e25–e146
McGee DL (2005) Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 15:87–97
Flegal KM, Graubard BI, Williamson DF, Gail MH (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293:1861–1867
Martin JL, Jia G, Martin SS, Shapiro TA, Herrmann HC, Dibattiste PM, Topol EJ, Moliterno DJ (2006) The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice. Catheter Cardiovasc Interv 67:563–570
Mehta L, Devlin W, McCullough PA, O’Neill WW, Skelding KA, Stone GW, Boura JA, Grines CL (2007) Impact of body mass index on outcomes after percutaneous coronary intervention in patients with acute myocardial infarction. Am J Cardiol 99: 906–910
Nikolsky E, Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Negoita M, Lansky AJ, Mehran R (2006) Impact of body mass index on outcomes after primary angioplasty in acute myocardial infarction. Am Heart J151:168–175
Kosuge M, Kimura K, Kojima S, Sakamoto T, Ishihara M, Asada Y, Tei C, Miyazaki S, Sonoda M, Tsuchihashi K, Yamagishi M, Shirai M, Hiraoka H, Honda T, Ogata Y, Ogawa H; Japanese Acute Coronary Syndrome Study (JACSS) Investigators (2008) Impact of body mass index on in-hospital outcomes after percutaneous coronary intervention for ST segment elevation acute myocardial infarction. Circ J 72:521–525
Niraj A, Pradhan J, Fakhry H, Veeranna V, Afonso L (2007) Severity of coronary artery disease in obese patients undergoing coronary angiography: “obesity paradox” revisited. Clin Cardiol 30:391–396
Gruberg L, Mercado N, Milo S, Boersma E, Disco C, van Es GA, Lemos PA, Ben Tzvi M, Wijns W, Unger F, Beyar R, Serruys PW; Arterial revascularization Therapies Study Investigators (2005) Impact of body mass index on the outcome of patients with multi-vessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II? Am J Cardiol 95:439–444
Gurm HS, Brennan DM, Booth J, Tcheng JE, Lincoff AM, Topol EJ (2002) Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox). Am J Cardiol 90:42–45
Buettner HJ, Mueller C, Gick M, Ferenc M, Allgeier J, Comberg T, Werner KD, Schindler C, Neumann FJ (2007) The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction. Eur Heart J 28:1694–1701
Minutello RM, Chou ET, Hong MK, Bergman G, Parikh M, Iacovone F, Wong SC (2004) Impact of body mass index on inhospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry). Am J Cardiol 93:1229–1232
Ellis SG, Elliott J, Horrigan M, Raymond RE, Howell G (1996) Low-normal or excessive body mass index: newly identified and powerful risk factors for death and other complications with percutaneous coronary intervention. Am J Cardiol 78:642–646
Gruberg L, Weissman NJ, Waksman R, Fuchs S, Deible R, Pinnow EE, Ahmed LM, Kent KM, Pichard AD, Suddath WO, Satler LF, Lindsay J Jr (2002) The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol 39:578–584
Ndrepepa G, Braun S, Iijima R, Keta D, Byrne RA, Schulz S, Mehilli J, Schömig A, Kastrati A (2009) Total leukocyte count but not C-reactive protein predicts one-year mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention. Clin Sci 116:651–658
TIMI Study Group (2008) Definitions used in TIMI trials. Available at: http://www.timi.org. accessed October 6, 2008
van Domburg RT, Sonnenschein K, Nieuwlaat R, Kamp O, Storm CJ, Bax JJ, Simoons ML (2005) Sustained benefit 20 years after reperfusion therapy in acute myocardial infarction. J Am Coll Cardiol 46:15–20
Franzosi MG, Santoro E, De Vita C, Geraci E, Lotto A, Maggioni AP, Mauri F, Rovelli F, Santoro L, Tavazzi L, Tognoni G (1998) Ten-year follow-up of the first megatrial testing thrombolytic therapy in patients with acute myocardial infarction: results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto-1 study. The GISSI Investigators. Circulation 98:2659–2665
Ndrepepa G, Berger PB, Mehilli J, Seyfarth M, Neumann FJ, Schömig A, Kastrati A (2008) Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol 51:690–697
Gurm HS, Whitlow PL, Kip KE; BARI Investigators (2002) The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). J Am Coll Cardiol 39:834–840
Takaya J, Iwamoto Y, Higashino H, Kino M, Kobayashi T, Kobayashi Y (1997) Altered intracellular calcium and phorbol 12,13-dibutyrate binding to intact platelets in young obese subjects. J Lab Clin Med 129:245–250
Kotlyar M, Carson SW (1999) Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther 37:8–19
Davì G, Guagnano MT, Ciabattoni G, Basili S, Falco A, Marinopiccoli M, Nutini M, Sensi S, Patrono C (2002) Platelet activation in obese women: role of inflammation and oxidant stress. JAMA 288:2008–2014
Tamminen M, Lassila R, Westerbacka J, Vehkavaara S, Yki-Järvinen H (2003) Obesity is associated with impaired platelet-inhibitory effect of acetylsalicylic acid in nondiabetic subjects. Int J Obes Relat Metab Disord 27:907–911
Feher G, Koltai K, Alkonyi B, Papp E, Keszthelyi Z, Kesmarky G, Toth K (2007) Clopidogrel resistance: role of body mass and concomitant medications. Int J Cardiol 120:188–192
Geisler T, Langer H, Wydymus M, Göhring K, Zürn C, Bigalke B, Stellos K, May AE, Gawaz M (2006) Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J 27:2420–2425
Buonamici P, Marcucci R, Migliorini A, Gensini GF, Santini A, Paniccia R, Moschi G, Gori AM, Abbate R, Antoniucci D (2007) Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis. J Am Coll Cardiol 49:2312–2317
Basili S, Pacini G, Guagnano MT, Manigrasso MR, Santilli F, Pettinella C, Ciabattoni G, Patrono C, Davì G (2006) Insulin resistance as a determinant of platelet activation in obese women. J Am Coll Cardiol 48:2531–2538
Lundergan CF, Reiner JS, McCarthy WF, Coyne KS, Califf RM, Ross AM (1998) Clinical predictors of early infarct-related artery patency following thrombolytic therapy: importance of body weight, smoking history, infarct-related artery and choice of thrombolytic regimen: the GUSTO-I experience. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. J Am Coll Cardiol 32:641–647
Kojima S, Funahashi T, Otsuka F, Maruyoshi H, Yamashita T, Kajiwara I, Shimomura H, Miyao Y, Fujimoto K, Sugiyama S, Sakamoto T, Yoshimura M, Ogawa H (2007) Future adverse cardiac events can be predicted by persistently low plasma adiponectin concentrations in men and marked reductions of adiponectin in women after acute myocardial infarction. Atherosclerosis 194:204–213
Kotani K, Sakane N, Saiga K, Kato M, Ishida K, Kato Y, Kurozawa Y (2007) Serum adiponectin levels and lifestyle factors in Japanese men. Heart Vessels 22:291–296
Mohamed-Ali V, Goodrick S, Bulmer K, Holly JM, Yudkin JS, Coppack SW (1999) Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol 277(6 pt 1):E971–E975
Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 101:2149–2153
Messerli FH, Sundgaard-Riise K, Reisin E, Dreslinski G, Dunn FG, Frohlich E (1983) Disparate cardiovascular effects of obesity and arterial hypertension. Am J Med 74:808–812
Diercks DB, Roe MT, Mulgund J, Pollack CV Jr, Kirk JD, Gibler WB, Ohman EM, Smith SC Jr, Boden WE, Peterson ED (2006) The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J 152:140–148
Rubinshtein R, Halon DA, Jaffe R, Shahla J, Lewis BS (2006) Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography Am J Cardiol 97:1277–1280
Kubota N, Kasai T, Miyauchi K, Njaman W, Kajimoto K, Akimoto Y, Kojima T, Ken Y, Takeshi K, Hiroyuki D (2008) Therapy with statins and aspirin enhances long-term outcome of percutaneous coronary intervention. Heart Vessels 23:35–39
Wannamethee G, Shaper AG (1989) Body weight and mortality in middle aged British men: impact of smoking. BMJ 299: 1497–1502
Tremblay A, Bandi V (2003) Impact of body mass index on outcomes following critical care. Chest 123:1202–1207
Nigam A, Wright RS, Allison TG, Williams BA, Kopecky SL, Reeder GS, Murphy JG, Jaffe AS (2006) Excess weight at time of presentation of myocardial infarction is associated with lower initial mortality risks but higher long-term risks including recurrent re-infarction and cardiac death. Int J Cardiol 110:153–159
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Ndrepepa, G., Keta, D., Byrne, R.A. et al. Impact of body mass index on clinical outcome in patients with acute coronary syndromes treated with percutaneous coronary intervention. Heart Vessels 25, 27–34 (2010). https://doi.org/10.1007/s00380-009-1160-3
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DOI: https://doi.org/10.1007/s00380-009-1160-3