What question did this study set out to answer?

To evaluate the long-term association between body mass index and clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention.

January 1, 2020EuroIntervention

The obesity paradox revisited: body mass index and long-term outcomes after PCI from a large pooled patient-level database

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Why the study?

The study was designed to evaluate the relationship between body mass index and outcomes in patients with coronary artery disease undergoing percutaneous revascularisation.

Does increased BMI improve long-term survival in patients with coronary artery disease undergoing PCI?

Population

22,922 patients with coronary artery disease undergoing percutaneous revascularisation in 13 randomised trials

Comparison

Underweight, overweight, and Class I-III obese categories vs normal weight

Design

Pooled patient-level analysis of 13 randomised trials

Authors

RWRafał WolnyCedars-Sinai Medical Center AMAkiko MaeharaInterventional Cardiology YLYangbo LiuFourth Hospital of Changsha

Discussion

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Implication

Moderately increased BMI (overweight and Class I obesity) is associated with improved 5-year survival post-PCI compared to normal weight, primarily due to lower non-cardiac mortality, supporting the existence of an 'obesity paradox'.

Key Points

To evaluate the long-term association between body mass index and clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention.
Pooled patient-level data from 13 randomized trials evaluating 22,922 patients undergoing percutaneous coronary intervention.
Stratified participants by body mass index into underweight (<18.5 kg/m²), normal weight (18.5 to <25 kg/m², reference), overweight (25 to <30 kg/m²), and obesity classes I (30 to <35 kg/m²), II (35 to <40 kg/m²), and III (≥40 kg/m²).
Assessed primary endpoint of 5-year all-cause mortality, alongside secondary endpoints including cardiac and non-cardiac death, revascularization, myocardial infarction, and stent thrombosis.
Overweight (HR 0.83, 95% CI: 0.71–0.96) and Class I obesity (HR 0.83, 95% CI: 0.69–0.96) were associated with significantly lower 5-year all-cause mortality compared with normal weight, predominantly driven by reduced non-cardiac death (HR 0.77, 95% CI: 0.63–0.94 for overweight).
Severe obesity (Class III) was associated with significantly increased cardiac mortality compared with normal weight (HR 1.62, 95% CI: 1.05–2.51).
Class II obesity was associated with higher rates of non-target lesion revascularization (HR 1.28, 95% CI: 1.04–1.58), but obesity showed no significant associations with target lesion revascularization, myocardial infarction, or stent thrombosis.

Structured PICO

Does increased BMI improve long-term survival in patients with coronary artery disease undergoing PCI?

Population

22,922 patients with coronary artery disease undergoing percutaneous revascularisation (PCI) pooled from 13 randomised trials

Intervention

Overweight (25 ≤BMI <30) and obese (Class I [30 ≤BMI <35], Class II [35 ≤BMI <40], or Class III [BMI ≥40]) categories

Comparator

Normal weight (18.5 ≤BMI <25)

Outcome

All-cause death at five yearshard clinical

Cite This Study

Wolny et al. (2020) studied this question.

synapsesocial.com/papers/6a87360648ef9afcd2a26976 https://doi.org/10.4244/eij-d-19-00467

Topics

Coronary artery disease Percutaneous coronary intervention

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The obesity paradox revisited: body mass index and long-term outcomes after PCI from a large pooled patient-level database

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

The obesity paradox revisited: body mass index and long-term outcomes after PCI from a large pooled patient-level database

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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