- •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.
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.
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.
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).
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.
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Published online: June 18, 2019
Accepted: June 18, 2019
Received in revised form: May 30, 2019
Received: May 1, 2019
© 2019 Published by Elsevier B.V.