Holdroyd, E, Sirker, A, Kwok, CS ORCID: https://orcid.org/0000-0001-7047-1586, Kontopantelis, E, Ludman, P, De Belder, MA, Butler, R, Cotton, J, Zaman, A and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2017) The relationship of body mass index to percutaneous coronary intervention outcomes: Does the obesity paradox exist in contemporary PCI cohorts? Insights from the British Cardiovascular Intervention Society registry. JACC: Cardiovascular Interventions, 10 (13). pp. 1283-1292.

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Abstract

Objectives
The aims of this study were to examine the relationship between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI) and to determine the relevance of different clinical presentations requiring PCI to this relationship.

Background
Obesity is a growing problem, and studies have reported a protective effect from obesity compared with normal BMI for adverse outcomes after PCI.

Methods
Between 2005 and 2013, 345,192 participants were included. Data were obtained from the British Cardiovascular Intervention Society registry, and mortality data were obtained through the U.K. Office of National Statistics. Multiple logistic regression was performed to determine the association between BMI group (<18.5, 18.5 to 24.9, 25 to 30 and >30 kg/m2) and adverse in-hospital outcomes and mortality.

Results
At 30 days post-PCI, significantly lower mortality was seen in patients with elevated BMIs (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.80 to 0.93] 0.90 [95% CI: 0.82 to 0.98] for BMI 25 to 30 and >30 kg/m2, respectively). At 1 year post-PCI, and up to 5 years post-PCI, elevated BMI (either overweight or obese) was an independent predictor of greater survival compared with normal weight (OR: 0.70 [95% CI: 0.67 to 0.73] and 0.73 [95% CI: 0.69 to 0.77], respectively, for 1 year; OR: 0.78 [95% CI: 0.75 to 0.81] and 0.88 [95% CI: 0.84 to 0.92], respectively, for 5 years). Similar reductions in mortality were observed for the analysis according to clinical presentation (stable angina, unstable angina or non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction).

Conclusions
A paradox regarding the independent association of elevated BMI with reduced mortality after PCI is still evident in contemporary U.K. practice. This is seen in both stable and more acute clinical settings.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://dx.doi.org/10.1016/j.jcin.2017.03.013 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: body mass index, obesity, percutaneous coronary intervention, mortality, cardiovascular events
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Applied Clinical Sciences
Depositing User: Symplectic
Date Deposited: 13 Mar 2017 11:17
Last Modified: 19 Mar 2019 14:45
URI: http://eprints.keele.ac.uk/id/eprint/3016

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