Author + information
- Received March 30, 2017
- Revision received June 12, 2017
- Accepted June 26, 2017
- Published online January 1, 2018.
- Michela Faggioni, MDa,b,
- Usman Baber, MDa,
- Arash Ehteshami Afshar, MDc,
- Gennaro Giustino, MDa,
- Samantha Sartori, PhDa,
- Sabato Sorrentino, MDa,
- Philippe G. Steg, MDd,
- Giulio G. Stefanini, MD, PhDe,
- Stephan Windecker, MDf,
- Martin B. Leon, MDg,
- Gregg W. Stone, MDg,
- William Wijns, MDh,
- Patrick W. Serruys, MD, PhDi,
- Marco Valgimigli, MD, PhDf,
- Edoardo Camenzind, MDj,
- Giora Weisz, MDg,k,
- Pieter C. Smits, MDl,
- David E. Kandzari, MDm,
- Soren Galatius, MDn,
- Clemens Von Birgelen, MD, PhDo,
- Raban V. Jeger, MDp,
- Ghada W. Mikhail, MDq,
- Dipti Itchhaporia, MDr,
- Laxmi Mehta, MDs,
- Rebecca Ortega, MHAt,
- Hyo-Soo Kim, MDu,
- Adnan Kastrati, MDv,
- Alaide Chieffo, MDw,
- George D. Dangas, MD, PhDa,
- Marie-Claude Morice, MDx and
- Roxana Mehran, MDa,∗ ()
- aMount Sinai Hospital, New York, New York
- bCardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy
- cDepartment of Cardiology, StonyBrook School of Medicine, New York, New York
- dDépartement Hospitalo Universitaire Fibrose, Inflammation et Remodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France
- eDivision of Clinical and Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy
- fDepartment of Cardiology, Bern University Hospital, Bern, Switzerland
- gDepartment of Cardiology, Columbia University Medical Center, New York, New York
- hCardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium
- iDepartment of Cardiology, Erasmus MC, Rotterdam, the Netherlands
- jDepartment of Cardiology, Institut Lorrain du Coeur et des Vaisseaux University Hospital Nancy - Brabois, Vandoeuvre-lès-Nancy, France
- kDepartment of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
- lDepartment of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
- mPiedmont Heart Institute, Atlanta, Georgia
- nDepartment of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- oDepartment of Cardiology, Thoraxcentrum Twente, Enschede, the Netherlands
- pDepartment of Cardiology, University Hospital Basel, Basel, Switzerland
- qDepartment of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- rDepartment of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California
- sDepartment of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
- tDuke Clinical Research Institute, Durham, North Carolina
- uDepartment of Cardiology, Seoul National University Main Hospital, Seoul, Korea
- vDepartment of Cardiology, Herzzentrum, Munich, Germany
- wCardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
- xDepartment of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France
- ↵∗Address for correspondence:
Dr. Roxana Mehran, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives This study sought to investigate the effect of different body mass index (BMI) categories on clinical outcomes in female patients treated with percutaneous coronary intervention (PCI) and drug-eluting stents.
Background Patients with higher BMI might, paradoxically, have better long-term clinical outcomes after acute coronary syndrome treated with PCI.
Methods We pooled patient-level data for female participants from 26 randomized trials on PCI with drug-eluting stents. Patients were stratified into underweight (BMI, <18.5), normoweight (BMI, 18.5 to 24.9), overweight (BMI, 25 to 29.9), obese (BMI, 30 to 34.9), or morbidly obese (BMI, ≥35). The primary endpoint was major adverse cardiac events, a composite of death, myocardial infarction, or target lesion revascularization at 3 years.
Results Among 11,557 female patients included in the pooled database, 9,420 were treated with a drug-eluting stent and had BMI data available. Patients with higher BMI were significantly younger and with more cardiovascular risk factors. Only 139 patients were underweight and had significantly higher adjusted rates of cardiac mortality and all-cause mortality than the rest of the population (hazard ratio: 2.20 [1.31 to 3.71] compared with normoweight). There was a significantly lower frequency of unadjusted 3-year all-cause mortality in overweight, obese, and severely obese patients compared with normoweight. However, following multivariable analysis, a trend toward increased risk of death in severely obese patients was observed, describing an inverse “J”-shaped relation between BMI and 3-year mortality. Conversely, the relationship between BMI and other outcomes, such as major adverse cardiac events, was flat for normoweight and higher BMI.
Conclusions The risk of 3-year adjusted cardiac events did not differ across BMI groups, whereas the risk of all-cause mortality compared with normoweight was significantly higher in underweight patients and lower in overweight patients with a trend toward increased risk in the severely obese population.
Dr. Steg has received research grants (to INSERM U1148) from Merck, Servier, and Sanofi; has served as a speaker or consultant for Amarin, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, CSL-Behring, Daiichi-Sankyo, GlaxoSmithKline, Janssen, Eli Lilly, Medtronic, Merck-Sharpe Dohme, Novartis, Orexigen, Pfizer, Regado, Sanofi, Servier, and The Medicines Company; and is a stockholder of Aterovax. Dr. Stefanini has received speaker or consultant fees from Boston Scientific, B. Braun, and Edwards Lifesciences; and a research grant (to the Institution) from Boston Scientific. Dr. Windecker has received research contracts to the institution from Abbott Vascular, Boston Scientific, Biosensors, Cordis, Medtronic, Bracco, and Terumo. Dr. Wijns has received institutional grants from Abbott, MiCell, MicroPort, Terumo; he has received lecture fees from Abbott, Biotronik, MicroPort; and he is co-founder of Argonauts Partners. Fees or honoraria on behalf of Dr. Wijns from Boston Scientific, Medtronic, Abbott Vascular, Terumo, and Biosensors go to the Cardiovascular Center Aalst. Dr. Valgimigli has received honoraria for lectures or advisory board and research grants from Merck, Iroko, Eli Lilly, and Medtronic; honoraria for advisory board and lectures from The Medicines Company, Eli Lilly, Daiichi-Sankyo, St. Jude Medical, and Abbott Vascular; and honoraria for lectures from Cordis, Carbostent and Implantable Devices, and Terumo. Dr. Smits has received institutional research grants from Abbott Vascular, Boston Scientific, St. Jude Medical, and Terumo; and speaker fees from Abbott Vascular. Dr. Kandzari has received research or grant support from Medtronic, Abbott Vascular, Boston Scientific, Biotronik, Medinol, and Micell; and consulting honoraria from Medtronic and Boston Scientific. Dr. Galatius has received grant support from St. Jude Medical, Abbott Vascular, Terumo, and Biotronik; and advisory board honoraria from Eli Lilly and Servier. Dr. Von Birgelen is a consultant to and has received lecture fees or travel expenses from Abbott Vascular, Biotronik, Boston Scientific, Medtronic, and Merck Sharp and Dohme; and his research department, Thoraxcentrum Twente, has received educational or research grants from AstraZeneca, Abbott Vascular, Biotronik, Boston Scientific, and Medtronic. Dr. Kastrati has received honoraria from Abbott Vascular, Biosensors, Biotronik, Cordis, and Medtronic; and a patent application with respect to a biodegradable polymer stent coating. Dr. Dangas is a consultant for Boston Scientific. Dr. Mehran has received institutional research grant support from Eli Lilly/Daiichi-Sankyo, Inc., Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, Abbott Laboratories, Watermark Research Partners, Novartis, Medtronic, and AUM Cardiovascular; serves on the executive committee of and has received fees from Janssen Pharmaceuticals and Osprey Medical; and received consulting fees from Medscape, The Medicines Company, Boston Scientific, Merck & Company, Cardiovascular Systems Inc., Sanofi, Shanghai BraccoSine Pharmaceuticals, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 30, 2017.
- Revision received June 12, 2017.
- Accepted June 26, 2017.
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