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Title: Is there an obesity paradox after percutaneous coronary intervention in the contemporary era? An analysis from a multicenter Australian registry.
Austin Authors: Lancefield, Terase ;Clark, David J ;Andrianopoulos, Nick;Brennan, Angela L;Reid, Christopher M;Johns, Jennifer ;Freeman, Melanie;Charter, Kerrie;Duffy, Stephen J;Ajani, Andrew E;Proietto, Joseph ;Farouque, Omar 
Institutional Author: MIG (Melbourne Interventional Group) Registry
Affiliation: Department of Cardiology, Austin Health, Melbourne, Australia
Issue Date: 1-Jun-2010
Publication information: Jacc. Cardiovascular Interventions; 3(6): 660-8
Abstract: We sought to determine whether an obesity paradox exists in the contemporary era of percutaneous coronary intervention (PCI) and to explore potential clinical factors that might contribute.Previous studies have suggested that overweight and obese patients might have better outcomes after PCI than patients with a normal or low body mass index (BMI); however this "obesity paradox" remains poorly understood.We evaluated 4,762 patients undergoing PCI between April 1, 2004 and September 30, 2007, enrolled in the MIG (Melbourne Intervention Group) registry. Patients were classified as underweight, normal, overweight, class I obese, and class II to III obese, BMI <20, 20 to 25, 25.1 to 30, 30.1 to 35, and >35 kg/m(2), respectively. We compared in-hospital, 30-day, and 12-month outcomes.As BMI increased from <20 to >35 kg/m(2), there was a statistically significant, linear reduction in 12-month major adverse cardiac events (MACE) (21.4% to 11.9%, p = 0.008) and mortality (7.6% to 2.0%, p < 0.001). Obesity was, with multivariate analysis, an independent predictor of reduced 12-month MACE and showed a trend for reduced 12-month mortality. At 12 months, obese patients had higher use of aspirin, clopidogrel, beta-blockers, renin-angiotensin system blockers and statins.Compared with normal-weight individuals, overweight and obese patients had lower in-hospital and 12-month MACE and mortality rates after PCI. Moreover, obese patients had a higher rate of guideline-based medication use at 12 months, which might in part explain the obesity paradox seen after PCI.
Gov't Doc #: 20630460
DOI: 10.1016/j.jcin.2010.03.018
Journal: JACC. Cardiovascular interventions
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary.adverse effects.mortality
Body Mass Index
Cardiovascular Agents.therapeutic use
Cardiovascular Diseases.etiology
Chi-Square Distribution
Coronary Artery Disease.complications.mortality.therapy
Hospital Mortality
Kaplan-Meier Estimate
Logistic Models
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Appears in Collections:Journal articles

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