Impact of Body Composition Indices on Ten-year Mortality After Revascularization of Complex Coronary Artery Disease (From the Syntax Extended Survival Trial)

Abstract

Numerous studies have demonstrated a paradoxical association between higher baseline body mass index (BMI) and lower long-term mortality risk after coronary revascularization, known as the "obesity paradox", possibly relying on the single use of BMI. The current study is a post-hoc analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the SYNTAX trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with left-main coronary artery disease (LMCAD) or three-vessel disease (3VD). Patients were stratified according to baseline BMI and/or waist circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%) had available baseline BMI and WC data, respectively. Of those, 1,327 (73.8%) patients had High BMI (≥25 kg/m 2 ), whereas 705 (44.4%) patients had High WC (>102 cm for men or >88 cm for women). When stratified by both BMI and WC, 10-year mortality risk was significantly higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59; 95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In conclusion, the "obesity paradox" following coronary revascularization would be driven by low long-term mortality risk of the High BMI/Low WC group. Body composition should be assessed by the combination of BMI and WC in the appropriate evaluation of the longterm risk of obesity in patients with LMCAD or 3VD.

Prognostic impact of in‐stent restenosis in normal weight, overweight, and obese patients undergoing percutaneous coronary intervention

“…In previous analyses, patients with below‐normal BMI and class III obesity had an increased mortality after PCI (mostly due to noncardiac causes), while patients with overweight and class I–II obesity had a lower risk, which determined a U ‐shaped association between BMI and mortality 10,19,20 . In other reports, higher BMI was related with a progressive decrease in mortality, 9 even after high‐risk procedures such as PCI of left main or three vessels coronary artery disease, 21 or PCI of chronic total occlusion 22 . The missing mitigation of the ISR‐related risks in overweight or obese patients in the current study could be explained by the fact that, at variance with the above‐mentioned studies, patients presenting with MI or treated with BMS implantation were excluded, and the reference group (i.e., with normal BMI) did not comprise underweight patients (<18.5 kg/m 2 ).…”

Association between Cardiovascular Risk Factors and High-risk Features in Myocardial Perfusion Imaging: A Multicenter Study

“… 44 Furthermore, a more detailed prognosis requires the assessment of central obesity by measuring waist circumference. 45 …”

Body Mass Index Is Independently Associated with the Presence of Ischemia in Myocardial Perfusion Imaging

“…A post-hoc breakdown of the SYNTAX Extended Survival study in patients with left main coronary artery disease that was revascularized either with coronary artery bypass surgery or percutaneous coronary intervention, showed that patients with either low baseline BMI and low WC, or low BMI/high WC, or high BMI/high WC, exhibited higher 10-year mortality risk compared to patients with high BMI/low WC. These findings suggest that the long-term prognosis of patients after coronary artery revascularization was favored by the baseline high BMI/low WC profile, possibly explaining the obesity paradox and suggesting that assessment of central obesity (either by evaluation of body composition or simply by measurement of WC) should be performed in patients prior to revascularization interventions for a more accurate prognosis [ 44 ]. Furthermore, another study demonstrated that patients admitted to hospital for management of acute myocardial infarction had better prognosis when they were overweight or obese, followed by those with normal weight, while underweight patients exhibited the worst prognosis.…”