Key result
Being underweight was associated with a significantly higher risk of the primary composite outcome (HR 2.183) compared to normal weight during chronic antiplatelet monotherapy after percutaneous coronary intervention.
Why the study?
To evaluate the association of body mass index with adverse clinical outcomes during chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention with drug-eluting stents.
Does body mass index affect the risk of major adverse cardiovascular and bleeding events in patients on chronic antiplatelet monotherapy after PCI with DES?
Cohort (n=5,112)
Open-label
1:1 (for the underlying trial)
Yes
Does body mass index affect the risk of major adverse cardiovascular and bleeding events in patients on chronic antiplatelet monotherapy after PCI with DES?
Effect estimate: HR 2.183 (95% CI 1.199-3.974)
Absolute Event Rate: 15.8% vs 7.7%
p-value: p=0.011
Lower BMI is associated with a higher risk of adverse clinical events and major bleeding during chronic antiplatelet monotherapy after PCI, while obesity is associated with a lower risk, supporting the obesity paradox.
Underweight patients on chronic antiplatelet monotherapy post-PCI may need closer surveillance; supports obesity paradox but leaves causal inference open.
BACKGROUND: This study evaluated the association of body mass index (BMI) with adverse clinical outcomes during chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS AND RESULTS: ) into underweight (BMI ≤18.4), normal weight (18.5-22.9), overweight (23.0-24.9), obesity (25.0-29.9) and severe obesity (≥30.0) categories with randomized antiplatelet monotherapy of aspirin 100 mg or clopidogrel 75 mg once daily for 24 months. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome and major bleeding of Bleeding Academic Research Consortium type ≥3. Compared with normal weight, the risk of primary composite outcomes was higher in the underweight (hazard ratio [HR] 2.183 [1.199-3.974]), but lower in the obesity (HR 0.730 [0.558-0.954]) and severe obesity (HR 0.518 [0.278-0.966]) categories, which is partly driven by the difference in all-cause death. The risk of major bleeding was significantly higher in the underweight (HR 4.140 [1.704-10.059]) than in the normal weight category. A decrease in categorical BMI was independently associated with the increased risk of primary composite outcomes. CONCLUSIONS: Lower BMI is associated with a higher risk of primary composite outcomes, which is primarily related to the events of all-cause death or major bleeding during chronic maintenance antiplatelet monotherapy after PCI with DES.
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Won et al. (2022) conducted a cohort in Patients undergoing chronic maintenance antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) (n=5,112). Underweight (BMI ≤18.4 kg/m2) vs. Normal weight (BMI 18.5-22.9 kg/m2) was evaluated on Composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome and major bleeding of BARC type ≥3 (HR 2.183, 95% CI 1.199-3.974, p=0.011). Being underweight was associated with a significantly higher risk of the primary composite outcome (HR 2.183) compared to normal weight during chronic antiplatelet monotherapy after percutaneous coronary intervention.
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