Highlights
- •Elderly patients increasingly undergo percutaneous coronary intervention (PCI).
- •Comprehensive risk stratification in this patient population is important.
- •In elderly patients, a lower BMI was related with an increased risk of mortality.
- •The BMI should be incorporated into the risk assessment of these patients.
Abstract
Background
The obesity paradox has been recognized in patients with cardiovascular disease. The
association between obesity and outcomes in elderly patients undergoing percutaneous
coronary intervention (PCI) has not been investigated, yet.
Methods
A total of 990 elderly (≥80 years) patients undergoing PCI at our institution between
January 2009 and December 2017 and with available data on body mass index (BMI) were
divided according to BMI tertiles (lowest BMI tertile: ≪24.1 kg/m2, middle BMI tertile: 24.1–27.2 kg/m2, and highest BMI tertile: ≫27.2 kg/m2). The primary endpoint was all-cause mortality at a median follow-up of 233 [34–862]
days.
Results
All-cause mortality was 11.2%, 7.6%, and 5.8% in the lowest, the middle, and the highest
BMI tertiles (Log Rank p = 0.008). Belonging to the lowest BMI tertile was associated
with an increased risk of all-cause mortality (HR 2.14, 95% CI 1.23–3.73, p = 0.007),
and associations remained significant after multivariable adjustments (adjusted HR
1.92, 95% CI 1.05–3.52, p = 0.03). While belonging to the lowest BMI tertile was independently
associated with an increased all-cause mortality in patients with acute coronary syndromes
(HR 2.32, 95% CI 1.24–4.35, p = 0.009; adjusted HR 2.40, 95% CI 1.19–4.84, p = 0.01),
relations were not significant in patients with stable coronary artery disease (HR
1.32, 95% CI 0.38–4.56, p = 0.67; adjusted HR 0.80, 95% CI 0.21–3.05, p = 0.75).
Conclusions
In elderly (≥80 years) patients undergoing PCI, belonging to the lowest BMI tertile
was associated with an increased mortality, mainly in acute coronary syndromes. Hence,
the BMI should be incorporated into the risk stratification of elderly patients with
coronary artery disease.
Keywords
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Article info
Publication history
Published online: June 18, 2019
Accepted:
June 18,
2019
Received in revised form:
May 30,
2019
Received:
May 1,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V.
