Impact of changes in body mass index after percutaneous coronary intervention on long-term outcomes in patients with cor
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ORIGINAL ARTICLE
Impact of changes in body mass index after percutaneous coronary intervention on long‑term outcomes in patients with coronary artery disease Hisanori Yui1 · Soichiro Ebisawa1 · Takashi Miura2 · Chie Nakamura1 · Shusaku Maruyama1 · Daisuke Kashiwagi1 · Ayumu Nagae1 · Takahiro Sakai1 · Tamon Kato1 · Tatsuya Saigusa1 · Ayako Okada1 · Hirohiko Motoki1 · Koichiro Kuwahara1 Received: 2 March 2020 / Accepted: 17 June 2020 © The Author(s) 2020
Abstract Little is known about the impact of changes in body mass index (BMI) after the percutaneous coronary intervention (PCI) on long-term outcomes in patients with coronary artery disease (CAD). Therefore, this study aimed to clarify this issue. We investigated data on CAD obtained from the SHINANO Registry, a prospective, observational, multicenter cohort study, from 2012 to 2013 in Nagano, Japan. One year after PCI, the enrolled patients were divided into the following three groups based on changes in BMI by tertiles: reduced, maintained, and elevated BMI. The associations among the groups and the 4-year outcomes [major adverse cardiac events (MACEs), all-cause death, Q-wave myocardial infarction, and stroke] were examined. Five hundred seventy-two patients were divided into the reduced, maintained, and elevated BMI groups. Over the 4-year follow-up period, the cumulative incidence of MACEs was 10.5% (60 cases). In the Kaplan–Meier analysis, the incidence rates of MACE were significantly higher in the reduced BMI group than in the maintained and elevated BMI groups [17.7% versus (vs.) 7.3% vs. 9.0%, p = 0.004]. Multivariable cox regression analysis showed that the reduced group showed increased risks of MACEs (hazard ratio 2.15; 95% confidence interval 1.29–3.57; p = 0.003). The long-term clinical outcomes of patients with CAD who underwent PCI were affected by the reduction in BMI after PCI. Furthermore, the elevation of BMI after PCI was not a poor prognostic factor. Keywords Obesity paradox · Percutaneous coronary intervention · Coronary artery disease · Prognosis
Introduction Obesity is a poor prognostic factor in the general population [1], and being lean is an important determinant of premature death [2]. Obesity is generally assessed by body mass index (BMI), and individuals with obesity (BMI of 30.0 kg/m2) have a high incidence of coronary artery disease (CAD) [3]. A previous report demonstrated that obesity is an independent risk factor for developing heart failure [4]. However, * Hisanori Yui hyui@shinshu‑u.ac.jp 1
Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3‑1‑1 Asahi, Matsumoto‑shi, Nagano 390‑8621, Japan
Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
2
weight loss has been reported to be an independent prognostic factor in patients who have already developed heart failure [5–7], and this is the “obesity paradox”. Little is known about the impact of changes in BMI after PCI on long-term outcomes in patients with CAD. Weight changes after PCI can be used to provide patients with car
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