By Lexa W. Lee
NEW ORLEANS -- November 12, 2008 -- Overweight and obese patients have better in-hospital outcomes after percutaneous coronary intervention (PCI). This phenomenon, called the obesity paradox, was confirmed in a study presented here at the American Heart Association (AHA) Scientific Sessions.
Among the general population, obesity has been associated with a greater risk of cardiovascular morality, but previous studies have observed that overweight and obese patients do better than normal weight patients after percutaneous or surgical coronary artery revascularisation.
To clarify the impact of body mass index (BMI) on outcomes after PCI, researchers led by Luis Gruberg, MD, Stony Brook University Medical Center, Stony Brook, New York, reassessed the reported observations using a large contemporary study group.
Baseline clinical, angiographic, and procedural characteristics, as well as in-hospital outcomes were collected prospectively from all patients undergoing PCI at 4 cardiac centres. Patients were then divided into 3 groups: normal (BMI <25), overweight (BMI 25-30), and obese (BMI >30).
The primary clinical endpoint was freedom from major adverse cardiac and cerebrovascular events (MACCE) at hospital discharge.
The study group consisted of 25,151 patients who underwent PCI between January 2004 and December 2007. Of these, 20,121 (80%) were overweight or obese. These patients were more often male, younger by about 6 years, and diabetic (21% of the normal group, average of 32.5% of the overweight and obese) compared with the normal-BMI group.
Rates of anterior wall infarction and shock were similar among the 3 groups, although the overweight and obese group had better left ventricular function.
Clinical characteristics and in-hospital outcomes were followed. MACCE (total of death, stroke, myocardial infarction) rates were as follows: normal weight group, 1.26%; overweight group, 0.72%; obese group, 0.53%, P < .0001.
The researchers concluded that overweight or obese patients undergoing PCI have better in-hospital outcomes compared with patients with normal BMI. This difference is driven by a lower incidence of each of the components of MACCE.
[Presentation title: The Obesity Paradox Revisited in a Large Contemporary Database: Overweight and Obese Patient Have Better Outcomes. Presentation 4506]
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