The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice

Jack L. Martin, Gang Jia, Seth S. Martin, Timothy A. Shapiro, Howard C. Herrmann, Peter M. DiBattiste, Eric J. Topol, David J. Moliterno

Research output: Contribution to journalArticle

Abstract

Objectives: We analyzed the relationship of obesity, determined by body mass index (BMI), to short- and long-term outcomes in the TARGET trial. BACKGROUND: Previous studies have conflicting findings regarding the relationship of BMI to outcomes following percutaneous coronary intervention (PCI). Methods: The TARGET trial studied the use of glycoprotein (GP) IIb/IIIa inhibition in patients undergoing planned coronary stent placement. Results: Eighty-one percent of all patients were overweight (BMI > 25), 36% were obese (BMI > 30), and United States patients were more frequently obese (38.7% vs. 25.8%, P < 0.001). Obese patients had a similar 30-day ischemic event rate compared with nonobese patients, but less major bleeding (0.4% vs. 1.1%, P = 0.013). Six-month death and myocardial infarction rates were similar in obese and nonobese patients. There was a J-shaped relationship between 6-month target vessel revascularization (TVR) and BMI with the lowest incidence of TVR at BMI 27.5. Six-month TVR was higher in the morbidly (BMI > 35) obese (12.4% vs 8.7%, P < 0.05). In extremely (BMI > 32) obese patients, this relationship was more significant (TVR 11.3% vs. 8.5%, P = 0.007), particularly in patients <65 years of age (TVR 12.3% vs. 8.4%, P = 0.003). Conclusion: The majority of patients undergoing PCI are overweight, especially in the United States. Extreme obesity is associated with a significant increase in TVR following intent-to-stent PCI, especially in patients <65 years of age. With routine use of GP IIb/IIIa inhibitors, other long- and short-term ischemic events are similar in obese and nonobese patients. However, obese patients have significantly less major bleeding.

Original languageEnglish (US)
Pages (from-to)563-570
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2006
Externally publishedYes

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Keywords

  • Body mass index
  • Coronary artery disease
  • Glycoprotein IIb/IIIa inhibition
  • Percutaneous coronary intervention
  • Target vessel revascularization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Martin, J. L., Jia, G., Martin, S. S., Shapiro, T. A., Herrmann, H. C., DiBattiste, P. M., Topol, E. J., & Moliterno, D. J. (2006). The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice. Catheterization and Cardiovascular Interventions, 67(4), 563-570. https://doi.org/10.1002/ccd.20622