What is the clinical evidence from this study?

Study design: Cohort. Population: Percutaneous coronary intervention (n=10069454). Intervention: Overweight status vs. Normal weight. Primary outcome: In-hospital mortality (OR 0.46, 95% CI 0.39-0.55, p=<0.001).

What does this research mean for the field?

The obesity paradox holds partially in patients undergoing percutaneous coronary intervention, with overweight patients having the lowest mortality and morbidly obese patients losing the protective effect compared to normal-weight individuals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate the influence of different body weight categories on in-hospital mortality among adult patients undergoing percutaneous coronary intervention.

October 1, 2025AsiaInterventionOpen Access

The obesity paradox revisited – influence on the results of percutaneous coronary interventions

Q: What are the key findings of this study?

Overweight status was associated with the lowest in-hospital mortality following percutaneous coronary intervention (1.28%, OR 0.46) compared to normal weight (2.72%), partially supporting the obesity paradox.

Q: What does this research mean for the field?

The obesity paradox holds partially in patients undergoing percutaneous coronary intervention, with overweight patients having the lowest mortality and morbidly obese patients losing the protective effect compared to normal-weight individuals. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the influence of different body weight categories on in-hospital mortality among adult patients undergoing percutaneous coronary intervention.

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Key result

Overweight status is linked to ~54% lower in-hospital mortality post-PCI versus normal weight.

OR 0.46
95% CI 0.39-0.55
P<0.001
n=10,069,454

Why the study?

The role of the obesity paradox in patients undergoing PCI is controversial and requires clarification regarding weight categories' effect on mortality.

Population

10,069,454 adult patients undergoing PCI from the National Inpatient Sample database 2016-2020

Comparison

Weight categories including cachectic, normal-weight, overweight, obese, and morbidly obese patients

Authors

MMMohammad Reza MovahedUniversity of Arizona ANAllistair NathanUniversity of Arizona MHMehrtash HashemzadehUniversity of Arizona

Discussion

Member takes

Implication

Does not warrant altering PCI risk stratification by BMI; extends observational support for obesity paradox but requires prospective validation.

Key Points

To investigate the influence of different body weight categories on in-hospital mortality among adult patients undergoing percutaneous coronary intervention.
Retrospective cohort analysis of adult patients (>18 years) in the National Inpatient Sample database from 2016 to 2020 identified via ICD-10 codes (N=10,069,454).
Patients undergoing percutaneous coronary intervention were stratified across weight categories: cachectic, normal weight, overweight, obese, and morbidly obese.
Univariate and multivariate logistic regression analyses were conducted to evaluate all-cause in-hospital mortality risk across categories.
Mortality was 2.72% in normal-weight patients, whereas cachectic patients exhibited the highest mortality rate at 9.78% (unadjusted OR 3.88, 95% CI: 3.65–4.12, p<0.001; adjusted OR 3.65, 95% CI: 3.42–3.90, p<0.001).
Overweight patients had the lowest mortality rate at 1.28% (unadjusted OR 0.46, 95% CI: 0.39–0.55, p<0.001; adjusted OR 0.51, 95% CI: 0.43–0.61, p<0.001), followed by obese patients at 1.61% (unadjusted OR 0.58, 95% CI: 0.56–0.61, p<0.001; adjusted OR 0.68, 95% CI: 0.66–0.71, p<0.001).
Morbidly obese patients had a mortality rate of 2.05% (unadjusted OR 0.75, 95% CI: 0.42–0.78, p<0.001), but this protective association largely disappeared after multivariate adjustment (adjusted OR 0.96, 95% CI: 0.96–1.00, p=0.04).

Study Design

Type

Cohort (n=10,069,454)

Multicenter

Yes

PICO

Population

10,069,454 adult patients undergoing percutaneous coronary intervention identified from the US National Inpatient Sample database between 2016 and 2020.

Exposure / Comparator

Overweight status vs Normal weight

Primary Outcome

In-hospital mortality — OR 0.46 (0.39-0.55), p=<0.001

Main Result

Odds Ratio: 0.46 (95% CI 0.39–0.55)

Absolute Event Rate: 1.28% vs 2.72%

p-value: p=<0.001

Limitations

Retrospective analysis, not a randomized trial
Used ICD-10 coding for weight categories instead of true BMI
Inpatient population only, cannot evaluate stable outpatient population
No access to medication data
Mortality data only included total mortality without the ability to assess cardiac mortality

Cite This Study

Movahed et al. (2025) conducted a cohort in Percutaneous coronary intervention (n=10,069,454). Overweight status vs. Normal weight was evaluated on In-hospital mortality (OR 0.46, 95% CI 0.39-0.55, p=<0.001). Overweight status was associated with the lowest in-hospital mortality following percutaneous coronary intervention (1.28%, OR 0.46) compared to normal weight (2.72%), partially supporting the obesity paradox.

synapsesocial.com/papers/6aaddfaa178de3ee8b183219 https://doi.org/10.4244/aij-d-25-00006

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Implication

Does not warrant altering PCI risk stratification by BMI; extends observational support for obesity paradox but requires prospective validation.

The obesity paradox revisited – influence on the results of percutaneous coronary interventions

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Limitations

Cite This Study

The obesity paradox revisited – influence on the results of percutaneous coronary interventions

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider