Impact of body mass index on In-Hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry)1

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Abstract

Although obesity traditionally has been considered a risk factor for coronary revascularization, recent data from registry studies have shown a possible protective effect of obesity on outcomes after percutaneous coronary intervention (PCI). Using data from the New York State Angioplasty database over a 4-year period, we analyzed 95,435 consecutive patients who underwent PCI. Classification of body mass index (BMI) was: underweight (<18.5 kg/m2), healthy weight (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), moderate obesity (class I) (30 to 34.9 kg/m2), severe obesity (class II) (35 to 39.9 kg/m2), and very severe obesity (class III) (>40 kg/m2). In-hospital postprocedural mortality and complications were compared among these groups. Compared with healthy weight patients, patient with class I or II obesity had lower in-hospital mortality and major adverse cardiac events (MACE) (combined death, myocardial infarction, and emergency surgery), whereas patients at the extremes of BMI (underweight and class III obese patients) had significantly higher mortality and MACE rates. Adjusted hazards ratios for in-hospital mortality according to BMI were: underweight (2.69), healthy weight (1.0), overweight (0.90), class I obese (0.74), class II obese (0.67), and class III obese (1.63). Patients at the extremes of BMI (<18.5 and >40 kg/m2) were at increased risk of MACEs, including mortality after PCI, whereas patients who were moderately to severely obese (BMIs 30 to 40 kg/m2) were at lower risk than healthy weight patients.

Section snippets

Patient population

The New York State Coronary Angioplasty Reporting System was initiated in 1991. It represents a collaborative effort between the New York State Department of Health and all New York State hospitals with privileges to perform angioplasty. The registry provides a mechanism for uniform reporting of all angioplasty procedure results and generates a database for evaluation of clinical outcomes as well as for dissemination of pertinent information for physicians, hospitals, and the general public.

Patient population

Baseline patient clinical characteristics and angiographic data are listed in Table 1. Obese patients accounted for 29.7% of all PCIs performed. Patients with a higher BMI were more likely to be younger, with an average age difference of >10 years across all BMI groups. Obese patients were more likely to be diabetic and hypertensive. However, they were less likely to have congestive heart failure, acute coronary syndromes (unstable angina or acute myocardial infarction), to have a history of

Discussion

This analysis is the largest to date demonstrating the impact of BMI and in-hospital outcomes after PCI. Several reports have found extremes of BMI to be associated with worse outcomes. Ellis et al8 found patients with BMI of ≤25 kg/m2 and >35 kg/m2 to have an increase in fatal risk after PCI, with higher rates of in-hospital mortality. Powell et al6 found a similar relation between mortality and BMI after PCI, with an increased risk at the very extremes of BMI. In contrast, Gurm et al5

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*This study was performed with the permission of the New York State Department of Health, which retains ownership of the registry.

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