Impact of BMI on 10-Year Outcomes After PCI with Drug-Eluting Stents

Overview

This pooled analysis of 9486 patients from five randomized trials evaluated the association between body mass index (BMI) and 10-year clinical outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Underweight patients had a significantly higher risk of all-cause death, while overweight patients showed a lower risk compared to normal-weight individuals. Obese patients had comparable mortality but increased early stent thrombosis risk and reduced repeat revascularization.

Background

Obesity and overweight status are increasingly prevalent and recognized risk factors for coronary artery disease (CAD). However, the relationship between BMI and long-term outcomes after PCI with DES remains unclear, with some studies suggesting an 'obesity paradox' where higher BMI associates with better short-term outcomes. This study pooled individual patient data from five randomized trials with 10-year follow-up to clarify the impact of BMI on mortality and cardiovascular events after PCI with DES.

Data Highlights

Key Findings

• Underweight patients had a significantly increased 10-year all-cause mortality risk compared to normal-weight patients (adjusted HR 1.58).
• Overweight patients exhibited a significantly lower risk of all-cause and cardiovascular death compared to normal-weight patients (adjusted HR 0.84).
• Obese patients had mortality risks comparable to normal-weight patients but showed a higher risk of definite stent thrombosis within 30 days post-PCI.
• Both overweight and obese patients had increased early stent thrombosis risk within 30 days after PCI.
• Obese patients experienced a significantly lower risk of target lesion revascularization (repeat revascularization) compared to normal-weight patients.
• The relationship between BMI and mortality demonstrated a U-shaped, non-linear association, indicating increased risk at both low and high BMI extremes.

Clinical Implications

Baseline BMI should be considered when assessing long-term prognosis after PCI with DES. Underweight patients may require closer monitoring and aggressive secondary prevention due to higher mortality risk. The increased early stent thrombosis risk in overweight and obese patients highlights the need for vigilant post-procedural care. The findings support tailored secondary prevention strategies based on BMI to optimize long-term outcomes.

Conclusion

BMI at the time of PCI with DES implantation significantly influences 10-year clinical outcomes, with underweight status associated with higher mortality and overweight status linked to improved survival. These results underscore the importance of individualized patient management considering BMI in secondary prevention.

References

1. DECADE Collaboration 2024 -- Impact of Body Mass Index on Decadal Outcomes in Patients Undergoing PCI with DES