Effect of Obesity on Coronary Atherosclerosis and Outcomes of Percutaneous Coronary Intervention

Abstract

O besity contributes to the development and progression of coronary artery disease and adverse events, in part, by reducing insulin sensitivity and promoting basal sympathetic tone, hypercoagulability, and systemic inflammation. 1,2 Conversely, in patients with established coronary artery disease, the effect of obesity on clinical outcomes remains controversial. [3][4][5][6] Recent studies suggest that an increased body mass index (BMI) is associated with a decreased mortality and major adverse cardiac events, especially in patients who undergo percutaneous coronary intervention (PCI) 7,8 ; however, the mechanism of the so-called obesity paradox is not yet understood.Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) 9 was a large-scale, prospective, multicenter study designed to assess the relationship between platelet reactivity and other clinical and procedural variables versus subsequent stent thrombosis and other adverse clinical events in patients treated with DES. In an intravascular Background-Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood. Methods and Results-Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4 2 ) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts. Conclusions-A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794. Kang et al Effect of Obesity in Coronary Atherosclerosisultrasound (IVUS) substudy, culprit lesions were prospectively evaluated using grayscale and virtual histology (VH)-IVUS, and patients were treated with IVUS-guided DES implantation. The aims of the...

Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients

“…The performance of coronary interventions in obese patients has steadily increased during the last few decades 31 and has been shown to be associated with fewer repeated revascularizations in obese patients than non-obese patients, possibly due to a larger external elastic membrane that preserves the lumen dimensions, larger stent area, and presence of beneficial vasoactive properties that may offset the adverse effects of excess adipose tissue. 32 In the current study, we were unable to demonstrate the existence of the obesity paradox in our PCI population. Periprocedural complications during the hospital stay, the length of hospitalization, and the incidence of major adverse cardiovascular events at 1 year were not different between the obese group and the other two groups.…”

Coronary Atherosclerotic Plaque Characteristics and Cardiovascular Risk Factors ― Insights From an Optical Coherence Tomography Study ―

“…In detail, a recent intravascular ultrasound study performed in patients with stable CAD or ACS found a greater plaque burden and plaque area, as well as higher incidence of plaque rupture, in patients with higher BMI compared with patients with lower BMI. 25 A non-invasive study investigating the relationship between coronary plaque characteristics by computed tomography (CT)-coronary angiography and visceral adipose tissue, observed a significant association between the latter and the amount of prothrombotic status induced by DM-associated metabolic abnormalities. 9 Interestingly, a recent study enrolling both diabetic and non-diabetic patients with their first ACS showed that high glycemic variability was associated with increased plaque vulnerability in non-culprit lesions.…”

Evolution of nonculprit coronary atherosclerotic plaques assessed by serial virtual histology intravascular ultrasound in patients with ST-segment elevation myocardial infarction and chronic total occlusion

“…The BMI of our population was lower than those of Raber and colleagues (27.5±3.8 kg/m 2 ) and Zhao and colleagues (27.0±2.4 kg/m 2 ). A relationship between high BMI and plaque progression has been reported 29,30. Second, 90% of patients in the STEMI group were new statin users.…”