Impact of Body Mass Index on the Clinical Outcomes after Percutaneous Coronary Intervention in Patients ≥75 Years Old

Abstract

Background:The impact of body mass index (BMI) on the clinical outcomes after percutaneous coronary intervention (PCI) in patients ≥75 years old remained unclear.Methods:A total of 1098 elderly patients undergoing PCI with stent implantation were recruited. Patients were divided into four groups by the value of BMI: Underweight (≤20.0 kg/m2), normal weight (20.0–24.9 kg/m2), overweight (25.0–29.9 kg/m2) and obese (≥30.0 kg/m2). Major clinical outcomes after PCI were compared between the groups. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACEs), which included death, myocardial infarction (MI) and target vessel revascularization. The secondary endpoint was defined as 1 year death. Logistic regression analysis was performed to adjust for the potential confounders.Results:Totally, 1077 elderly patients with available BMIs were included in the analysis. Patients of underweight, normal weight, overweight and obese accounted for 5.6%, 45.4%, 41.5% and 7.5% of the population, respectively. Underweight patients were more likely to attract ST-segment elevation MI, and get accompanied with anemia or renal dysfunction. Meanwhile, they were less likely to achieve thrombolysis in MI 3 grade flow after PCI, and receive beta-blocker, angiotensin converting enzyme inhibitor or angiotensin receptor blocker after discharge. In underweight, normal weight, overweight and obese patients, in-hospital MACE were 1.7%, 2.7%, 3.8%, and 3.7% respectively (P = 0.68), and 1 year mortality rates were 5.0%, 3.9%, 5.1% and 3.7% (P = 0.80), without significant difference between the groups. Multivariate regression analysis showed that the value of BMI was not associated with in-hospital MACE in patients at 75 years old.Conclusions:The BMI “obese paradox” was not found in patients ≥75 years old. It was suggested that BMI may not be a sensitive predictor of adverse cardiovascular events in elderly patients.

Does an Obesity Paradox Really Exist After Cardiovascular Intervention?

“…Data from study Sandeep 2011, 22 Won 2010, 25 Hidehiro 2013, 24 Ibrahim 2012 9 , Pei 2015, 30 Yohei 2015, 29 Zhi 2012, 23 Heinz 2007 19 and, Shubair 2006 18 have been used to calculate the percentage of patients with their corresponding medications during the follow-up period and have been represented in Table 4 . Studies that have not been included in this section have been ignored because they did not report the medications being prescribed at hospital discharge or during the follow-up period.…”

Association of body mass index with mortality in Chinese patients after percutaneous coronary intervention: A large single‐center data

“…Studies conducted in Japan and South Korea indicated that a low BMI was associated with increased risks of major cardiovascular events and death among patients undergoing PCI . However, it was perplexing that studies performed in China so far consistently showed an absence of this phenomenon . Two of these studies, analyzing the same cohort of 7895 patients undergoing PCI between January 2004 and December 2006 in a Chinese center, failed to identify any association between BMI and mortality after PCI.…”

“…[8][9][10][11] However, it was perplexing that studies performed in China so far consistently showed an absence of this phenomenon. [19][20][21] Two of these studies, analyzing the same cohort of 7895 patients undergoing…”

“…The average BMI of Asian patients is markedly lower than that of patients in Western countries . Although “obesity paradox” has been proven in post‐PCI patients in Japan and Korea, it is notable that studies conducted in China have shown an absence of this paradox . The power of these previous studies in Asia was, however, all limited by their relatively small sample size.…”

“…[16][17][18] Although "obesity paradox" has been proven in post-PCI patients in Japan and Korea, [8][9][10][11] it is notable that studies conducted in China have shown an absence of this paradox. [19][20][21] The power of these previous studies in Asia was, however, all limited by their relatively small sample size. Therefore, we sought to re-examine this "obesity paradox" using a much larger sample size.…”