Soo-Jin Kang1, Gary S Mintz1, Bernhard Witzenbichler1, D Christopher Metzger1, Michael J Rinaldi1, Peter L Duffy1, Giora Weisz1, Thomas D Stuckey1, Bruce R Brodie1, Takehisa Shimizu1, Ke Xu1, Ajay J Kirtane1, Gregg W Stone1, Akiko Maehara2. 1. From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.). 2. From the Cardiovascular Research Foundation, New York, NY (S.-J.K., G.S.M., G.W., T.S., K.X., A.J.K., G.W.S., A.M.); Asan Medical Center, Seoul, Korea (S.-J.K.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Columbia University Medical Center, New York-Presbyterian Hospital, NY (G.W., T.S., A.J.K., G.W.S., A.M.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.). amaehara@crf.org.
Abstract
BACKGROUND: Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood. METHODS AND RESULTS: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts. CONCLUSIONS: A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
BACKGROUND:Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood. METHODS AND RESULTS: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts. CONCLUSIONS: A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Authors: Mohamad Jarrah; Ayman J Hammoudeh; Yousef Khader; Ramzi Tabbalat; Eyas Al-Mousa; Osama Okkeh; Imad A Alhaddad; Loai Issa Tawalbeh; Issa M Hweidi Journal: J Int Med Res Date: 2018-02-22 Impact factor: 1.671