Obesity Paradox—Does It Exist in the Contemporary South Indian Post-Percutaneous Coronary Intervention Population?

Background Obesity is a predisposing factor for atherosclerotic coronary arterial disease. Many studies have shown a protective effect of obesity for major adverse cardiovascular events after percutaneous coronary intervention (PCI). Aim The main purpose of this article is to assess the clinical characteristics, invasive angiographic features, and in-hospital cardiovascular events in obese patients compared with normal and underweight patients. We wanted to know the relationship between body mass index (BMI) and outcomes after PCI. Methods We conducted a prospective study among patients undergoing PCI. Between 2017 and 2019, we included 1,669 participants. Multiple logistic regression was performed to determine the effect of BMI on in-hospital adverse events. Results The patients were classified into four groups: obese (BMI ≥30 kg/m2), overweight (BMI 25 to <29.9 kg/m2), normal BMI (BMI 18.51 to <24.9 kg/m2), and underweight (BMI <18.5 kg/m2). Of 1,669 enrolled patients, 1,233 were men, and 436 were women. Among the women, 19 (35.8%) were underweight, 214(25.4%) were normal having normal BMI, 137 (23.5%) were overweight, and 66 (34%) were obese. Among the men, 34 (2.7%) were underweight, 626 (51%) has normal BMI, 445(36%) were overweight, and 128 (10.3%) were obese. Among 840 patients with normal BMI, 797 (95.4%) had no in-hospital events, 39 (4.6%) had in-hospital events. Among 582 patients who were overweight, 30 (5%) had in-hospital events, and 551 (95%) had no in-hospital events. Among 194 patients who were obese, 9 (4.6%) had in-hospital events and 181 (95.4%) had no in-hospital events. There were no in-hospital events in the underweight group. When in-hospital events were compared with different subgroups depending on the weight, it was not statistically significant (for obesity, p = 0.72, and underweight, p = 0.162). When the events in patients with higher than normal BMI (overweight and obese) were compared with events in underweight, it was statistically significant (p = 0.03). It means that a higher BMI was associated with a higher in-hospital event rate. Conclusion A paradox regarding the association of higher BMI with decreased in-hospital events after PCI is not seen in contemporary south Indian post PCI patients.