Author + information
- Received December 22, 2016
- Revision received February 9, 2017
- Accepted March 9, 2017
- Published online July 3, 2017.
- Eric W. Holroyd, MDa,
- Alex Sirker, MB, BChir, PhDb,
- Chun Shing Kwok, MBBS, BSc, MSca,c,
- Evangelos Kontopantelis, PhDd,
- Peter F. Ludman, MDe,
- Mark A. De Belder, MDf,
- Robert Butler, MBChB, MDa,
- James Cotton, MBBS, MDg,
- Azfar Zaman, MBChB, MDh,
- Mamas A. Mamas, BMBCh, DPhila,c,∗ (, )
- British Cardiovascular Intervention Society and National Institute of Cardiovascular Outcomes Research
- aAcademic Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
- bDepartment of Cardiology, University College London Hospitals and St. Bartholomew’s Hospital, London, United Kingdom
- cKeele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, United Kingdom
- dInstitute of Population Health, University of Manchester, Manchester, United Kingdom
- eQueen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom
- fThe James Cook University Hospital, Middlesbrough, United Kingdom
- gDepartment of Cardiology, The Heart and Lung Centre, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
- hFreeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- ↵∗Address for correspondence:
Prof. Mamas A. Mamas, Keele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent ST4 7QB, United Kingdom.
Objectives The aims of this study were to examine the relationship between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI) and to determine the relevance of different clinical presentations requiring PCI to this relationship.
Background Obesity is a growing problem, and studies have reported a protective effect from obesity compared with normal BMI for adverse outcomes after PCI.
Methods Between 2005 and 2013, 345,192 participants were included. Data were obtained from the British Cardiovascular Intervention Society registry, and mortality data were obtained through the U.K. Office of National Statistics. Multiple logistic regression was performed to determine the association between BMI group (<18.5, 18.5 to 24.9, 25 to 30 and >30 kg/m2) and adverse in-hospital outcomes and mortality.
Results At 30 days post-PCI, significantly lower mortality was seen in patients with elevated BMIs (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.80 to 0.93] 0.90 [95% CI: 0.82 to 0.98] for BMI 25 to 30 and >30 kg/m2, respectively). At 1 year post-PCI, and up to 5 years post-PCI, elevated BMI (either overweight or obese) was an independent predictor of greater survival compared with normal weight (OR: 0.70 [95% CI: 0.67 to 0.73] and 0.73 [95% CI: 0.69 to 0.77], respectively, for 1 year; OR: 0.78 [95% CI: 0.75 to 0.81] and 0.88 [95% CI: 0.84 to 0.92], respectively, for 5 years). Similar reductions in mortality were observed for the analysis according to clinical presentation (stable angina, unstable angina or non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction).
Conclusions A paradox regarding the independent association of elevated BMI with reduced mortality after PCI is still evident in contemporary U.K. practice. This is seen in both stable and more acute clinical settings.
This work is funded by the University Hospitals of North Midlands Charity. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Holroyd, Sirker, and Kwok contributed equally to this work.
- Received December 22, 2016.
- Revision received February 9, 2017.
- Accepted March 9, 2017.
- 2017 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.