Michela Faggioni1, Usman Baber2, Arash Ehteshami Afshar3, Gennaro Giustino2, Samantha Sartori2, Sabato Sorrentino2, Philippe G Steg4, Giulio G Stefanini5, Stephan Windecker6, Martin B Leon7, Gregg W Stone7, William Wijns8, Patrick W Serruys9, Marco Valgimigli6, Edoardo Camenzind10, Giora Weisz11, Pieter C Smits12, David E Kandzari13, Soren Galatius14, Clemens Von Birgelen15, Raban V Jeger16, Ghada W Mikhail17, Dipti Itchhaporia18, Laxmi Mehta19, Rebecca Ortega20, Hyo-Soo Kim21, Adnan Kastrati22, Alaide Chieffo23, George D Dangas2, Marie-Claude Morice24, Roxana Mehran25. 1. Mount Sinai Hospital, New York, New York; Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy. 2. Mount Sinai Hospital, New York, New York. 3. Department of Cardiology, StonyBrook School of Medicine, New York, New York. 4. Département Hospitalo Universitaire Fibrose, Inflammation et Remodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France. 5. Division of Clinical and Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy. 6. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 7. Department of Cardiology, Columbia University Medical Center, New York, New York. 8. Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium. 9. Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands. 10. Department of Cardiology, Institut Lorrain du Coeur et des Vaisseaux University Hospital Nancy - Brabois, Vandoeuvre-lès-Nancy, France. 11. Department of Cardiology, Columbia University Medical Center, New York, New York; Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel. 12. Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands. 13. Piedmont Heart Institute, Atlanta, Georgia. 14. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. 15. Department of Cardiology, Thoraxcentrum Twente, Enschede, the Netherlands. 16. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 17. Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom. 18. Department of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California. 19. Department of Cardiology, The Ohio State University Medical Center, Columbus, Ohio. 20. Duke Clinical Research Institute, Durham, North Carolina. 21. Department of Cardiology, Seoul National University Main Hospital, Seoul, Korea. 22. Department of Cardiology, Herzzentrum, Munich, Germany. 23. Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy. 24. Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France. 25. Mount Sinai Hospital, New York, New York. Electronic address: Roxana.Mehran@mountsinai.org.
Abstract
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.
RCT Entities:
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 obesepatients compared with normoweight. However, following multivariable analysis, a trend toward increased risk of death in severely obesepatients 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.
Authors: Masafumi Ono; Ply Chichareon; Mariusz Tomaniak; Hideyuki Kawashima; Kuniaki Takahashi; Norihiro Kogame; Rodrigo Modolo; Hironori Hara; Chao Gao; Rutao Wang; Simon Walsh; Harry Suryapranata; Pedro Canas da Silva; James Cotton; René Koning; Ibrahim Akin; Benno J W M Rensing; Scot Garg; Joanna J Wykrzykowska; Jan J Piek; Peter Jüni; Christian Hamm; Philippe Gabriel Steg; Marco Valgimigli; Stephan Windecker; Robert F Storey; Yoshinobu Onuma; Pascal Vranckx; Patrick W Serruys Journal: Clin Res Cardiol Date: 2020-01-31 Impact factor: 5.460
Authors: Taylor D Ottesen; Rohil Malpani; Anoop R Galivanche; Cheryl K Zogg; Arya G Varthi; Jonathan N Grauer Journal: Spine J Date: 2020-03-16 Impact factor: 4.297