Key result
In elderly patients undergoing PCI, low BMI (HR 1.4; 95% CI 1.1-1.7) and low serum creatinine with normal BMI (HR 1.8; 95% CI 1.3-2.5) were associated with increased all-cause mortality.
Why the study?
Do low body mass index and low serum creatinine predict mortality in elderly patients undergoing percutaneous coronary intervention?
Cohort (n=9,394)
Do low body mass index and low serum creatinine predict mortality in elderly patients undergoing percutaneous coronary intervention?
In elderly patients undergoing PCI, low BMI and the combination of normal BMI with low serum creatinine are associated with increased long-term mortality, suggesting these surrogate markers of frailty predict worse outcomes.
Answers are grounded in this paper and cite their sources.
Low creatinine with normal BMI signals higher post-PCI mortality in elderly patients; hypothesis-generating for frailty markers, needs prospective validation.
BACKGROUND: Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause-specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. METHODS AND RESULTS: We determined long-term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow-up of 4.2 years (interquartile range 1.8-7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all-cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1-1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0-1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06-1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67-0.88; obese: HR 0.80, 95% CI 0.70-0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74-0.97; obese: HR 0.82, 95% CI 0.72-0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all-cause mortality (HR 1.8, 95% CI 1.3-2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4-3.8) compared with patients with normal creatinine (0.71-1.0 mg/dL); however, this was not observed in other BMI categories. CONCLUSIONS: We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all-cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight-gain strategies may have potential roles for these patients undergoing percutaneous coronary intervention.
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Goel et al. (2016) conducted a cohort in Patients undergoing percutaneous coronary intervention (n=9,394). Low body mass index (BMI) and low serum creatinine vs. Normal BMI and normal serum creatinine was evaluated on All-cause mortality (HR 1.4, 95% CI 1.1-1.7). In elderly patients undergoing PCI, low BMI (HR 1.4; 95% CI 1.1-1.7) and low serum creatinine with normal BMI (HR 1.8; 95% CI 1.3-2.5) were associated with increased all-cause mortality.
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