Key result
The highest body mass index category was associated with lower all-cause mortality compared to the lowest category in patients undergoing PCI (HR 0.60; 95% CI 0.45-0.82).
Why the study?
The association between body mass index and mortality in patients undergoing PCI remains controversial, raising questions about whether the obesity paradox truly exists.
Does higher body mass index reduce all-cause mortality in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=138,592)
Does higher body mass index reduce all-cause mortality in patients undergoing percutaneous coronary intervention?
Hazard Ratio: 0.6 (95% CI 0.45–0.82)
An 'obesity paradox' exists in patients undergoing PCI, characterized by a U-shaped association between BMI and all-cause mortality where the lowest risk occurs at a BMI of 27 to 32 kg/m2.
Supports obesity paradox in post-PCI patients; hypothesis-generating and should not yet change practice.
Summary The association between body mass index (BMI) and mortality of patients with percutaneous coronary intervention (PCI) is still controversial. We hope to explore whether the ‘obesity paradox’ really exists through this dose–response meta‐analysis. PubMed, Embase and Cochrane databases were systematically searched for eligible studies up to April 2020. The random‐effects restricted cubic spline models were used to evaluate the potential non‐linear relationship between BMI and all‐cause mortality of patients undergoing PCI. Fifteen studies were identified and included total 138 592 participants. The pooled hazard ratio of all‐cause mortality was 0.60 (95% confidence interval: 0.45–0.82) when compared the highest category (mean = 33.32 kg m −2 ) of BMI with the lowest category (mean = 18.89 kg m −2 ). A non‐linear U‐shaped dose–response curve between BMI and the risk of all‐cause mortality was found, with higher mortality rate at BMI lower than 27 kg m −2 and higher than 32 kg m −2 . The ‘obesity paradox’ does exist after PCI. The association between BMI and the risk of all‐cause mortality for patients undergoing PCI is U shaped, with a nadir of risk at a BMI of 27 to 32 kg m −2 and the highest risk at patients with underweight. The relationship between other prognostic indicators and BMI is worthy of further research.
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Mei et al. (2020) conducted a meta-analysis in percutaneous coronary intervention (n=138,592). Body mass index vs. Lowest category of BMI (mean 18.89 kg/m2) was evaluated on all-cause mortality (HR 0.60, 95% CI 0.45-0.82). The highest body mass index category was associated with lower all-cause mortality compared to the lowest category in patients undergoing PCI (HR 0.60; 95% CI 0.45-0.82).
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