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Obesity paradox in Japanese patients after percutaneous coronary intervention: An observation cohort study

2013; Elsevier BV; Volume: 62; Issue: 1 Linguagem: Inglês

10.1016/j.jjcc.2013.02.009

1876-4738

Hidehiro Kaneko, Junji Yajima, Yuji Oikawa, Shingo Tanaka, Daisuke Fukamachi, Shinya Suzuki, Koichi Sagara, Takayuki Otsuka, Shunsuke Matsuno, Ryuichi Funada, Hiroto Kano, Tokuhisa Uejima, Akira Koike, Kazuyuki Nagashima, Hajime Kirigaya, Hitoshi Sawada, Tadanori Aizawa, Takeshi Yamashita,

Acute Myocardial Infarction Research

Abstract Background The impact of obesity on Japanese patients who undergo primary percutaneous coronary intervention (PCI) remains unclear. Methods and results Within a single hospital-based cohort in the Shinken Database 2004–2010, which comprised all new patients ( n =15227) who visited the Cardiovascular Institute, we followed patients who underwent PCI. Major adverse cardiac events (MACE)—death, myocardial infarction, or target lesion revascularization (TLR)—were defined as the composite endpoint. A total of 1205 patients were included in this study (median follow-up of 1037±703 days): 92 lean [body-mass-index (BMI)<20]; 640 normal-weight (BMI=20–24.9); 417 overweight (BMI=25–29.9); and 56 obese (BMI≥30). Mean age decreased and male gender increased with increasing BMI. Classic coronary risk factors were more common in overweight and obese patients than in normal-weight and lean patients. Chronic kidney disease (CKD) was more common in lean patients than in overweight and obese patients. Patients taking dual antiplatelet therapy, statins, beta-blockers, and renin–angiotensin-system inhibitors increased in a BMI-dependent manner. Obese patients had a significantly lower frequency of MACE, all-cause death, cardiac death, and hospital admission for heart failure than lean patients. Multivariate analysis showed that BMI category was independently associated with all-cause death after PCI. Conclusion Over-weight and obese patients were independently associated with favorable long-term clinical outcomes after PCI, suggesting that obesity paradox was applicable to Japanese patients after PCI in real-world clinical setting.