Key result
Being overweight is linked to ~29% lower 1-year mortality after PCI versus normal BMI.
Why the study?
The relationship between body mass index and outcomes after PCI in a multiethnic South East Asian population was not well defined.
Does BMI category affect 1-year mortality and in-hospital outcomes after PCI in a multiethnic South East Asian population?
Cohort (n=28,742)
Yes
Does BMI category affect 1-year mortality and in-hospital outcomes after PCI in a multiethnic South East Asian population?
Hazard Ratio: 0.71
p-value: p=0.005
Using Asian-specific BMI cut-offs, overweight status is associated with a lower risk of 1-year mortality after PCI compared to normal BMI, supporting the existence of an obesity paradox in this population.
Overweight by Asian BMI cutoffs was associated with lower 1-year post-PCI mortality; extends obesity paradox observations in South East Asians but should not yet change practice.
Objective To examine the relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) in a multiethnic South East Asian population. Setting Fifteen participating cardiology centres contributed to the Malaysian National Cardiovascular Disease Database—Percutaneous Coronary Intervention (NCVD-PCI) registry. Participants 28 742 patients from the NCVD-PCI registry who had their first PCI between January 2007 and December 2014 were included. Those without their BMI recorded or BMI <11 kg/m 2 or >70 kg/m 2 were excluded. Main outcome measures In-hospital death, major adverse cardiovascular events (MACEs), vascular complications between different BMI groups were examined. Multivariable-adjusted HRs for 1-year mortality after PCI among the BMI groups were also calculated. Results The patients were divided into four groups; underweight (BMI <18.5 kg/m 2 ), normal BMI (BMI 18.5 to <23 kg/m 2 ), overweight (BMI 23 to <27.5 kg/m 2 ) and obese (BMI ≥27.5 kg/m 2 ). Comparison of their baseline characteristics showed that the obese group was younger, had lower prevalence of smoking but higher prevalence of diabetes, hypertension and dyslipidemia. There was no difference found in terms of in-hospital death, MACE and vascular complications after PCI. Multivariable Cox proportional hazard regression analysis showed that compared with normal BMI group the underweight group had a non-significant difference (HR 1.02, p=0.952), while the overweight group had significantly lower risk of 1-year mortality (HR 0.71, p=0.005). The obese group also showed lower HR but this was non-significant (HR 0.78, p=0.056). Conclusions Using Asian-specific BMI cut-off points, the overweight group in our study population was independently associated with lower risk of 1-year mortality after PCI compared with the normal BMI group.
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Azhari et al. (2017) conducted a cohort in Post-percutaneous coronary intervention (PCI) (n=28,742). Overweight body mass index (23 to <27.5 kg/m2) vs. Normal body mass index (18.5 to <23 kg/m2) was evaluated on 1-year mortality (HR 0.71, p=0.005). Compared with normal BMI, being overweight was independently associated with a significantly lower risk of 1-year mortality after percutaneous coronary intervention (HR 0.71, p=0.005).
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