The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?

J Am Coll Cardiol. 2002 Feb 20;39(4):578-84. doi: 10.1016/s0735-1097(01)01802-2.


Objectives: The purpose of this study was to assess the impact of body mass index (BMI) on the short- and long-term outcomes after percutaneous coronary intervention (PCI).

Background: Obesity is associated with advanced coronary artery disease (CAD). However, the relation between BMI and outcome after PCI remains controversial.

Methods: We studied 9,633 consecutive patients who underwent PCI between January 1994 and December 1999. Patients were divided into three groups according to BMI: normal, BMI between 18.5 and 24.9 (n = 1,923); overweight, BMI between 25 and 30 (n = 4,813); and obese, BMI >30 (n = 2,897).

Results: Obese patients were significantly younger and had consistently worse baseline clinical characteristics than normal or overweight patients, with a higher incidence of hypertension, diabetes, hypercholesterolemia and smoking history (p < 0.0001). Despite similar angiographic success rates among the three groups, normal BMI patients had a higher incidence of major in-hospital complications, including cardiac death (p = 0.001). At one-year follow-up, overall mortality rates were significantly higher for normal BMI patients compared with overweight or obese patients (p < 0.0001). Myocardial infarction and revascularization rates did not differ among the three groups. By multivariate Cox regression analysis, diabetes, hypertension, age, BMI and left ventricular function were independent predictors of long-term mortality.

Conclusions: In patients with known CAD who undergo PCI, very lean patients (BMI <18.5) and those with BMI within the normal range are at the highest risk for in-hospital complications and cardiac death and for increased one-year mortality.

MeSH terms

  • Age Factors
  • Aged
  • Angioplasty, Balloon, Coronary*
  • Body Mass Index*
  • Cohort Studies
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology*
  • Odds Ratio
  • Regression Analysis
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Treatment Outcome