No evidence of "obesity paradox" after treatment with drug-eluting stents in a routine clinical practice: results from the prospective multicenter German DES.DE (German Drug-Eluting Stent) Registry

JACC Cardiovasc Interv. 2012 Feb;5(2):162-9. doi: 10.1016/j.jcin.2011.09.021.


Objectives: The aim of this study was to compare clinical outcomes among unselected patients stratified in categories of body mass index, who underwent percutaneous coronary intervention (PCI) with either sirolimus-eluting or paclitaxel-eluting stents.

Background: Overweight and obesity are often considered risk factors for cardiovascular events. However, recent studies have associated obesity with better outcomes after PCI with bare-metal stents. Data from routine clinical practice using drug-eluting stents (DES) focusing on this "obesity paradox" are not available.

Methods: We used data from DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and 1-year outcomes among unselected patients undergoing PCI with DES implantation. Primary endpoints were the rate of major adverse cardiac and cerebrovascular events (MACCE) (defined as the composite of death, myocardial infarction, and stroke) and target vessel revascularization (TVR).

Results: Between October 2005 and 2006, 1,436 normal weight, 2,839 overweight, and 1,531 obese patients treated with DES were enrolled at 98 sites. Baseline clinical parameters were more severe in overweight and obese patients; 1-year follow-up comparison between groups revealed similar rates of all-cause death (3.3% vs. 2.4% vs. 2.4%; p=0.17), MACCE (7.1% vs. 5.6% vs. 5.5%; p=0.09), and TVR in survivors (10.9% vs. 11.7% vs. 11.6%; p=0.56) in normal weight individuals compared with overweight or obese patients. Such results persisted after risk-adjustment for heterogeneous baseline characteristics of groups and were independent of the types of DES.

Conclusions: DES.DE revealed no evidence of "obesity paradox" in a routine clinical practice using DES.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Antineoplastic Agents, Phytogenic / therapeutic use
  • Body Mass Index
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / therapy*
  • Drug-Eluting Stents*
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Obesity*
  • Paclitaxel / therapeutic use*
  • Proportional Hazards Models
  • Prospective Studies
  • Registries
  • Risk Factors
  • Sirolimus / therapeutic use*
  • Statistics as Topic


  • Antineoplastic Agents, Phytogenic
  • Immunosuppressive Agents
  • Paclitaxel
  • Sirolimus