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Impact of Body Mass Index on 5-Year Clinical Outcomes in Patients With STâ\u80\u93Segment Elevation Myocardial Infarction After Everolimus-Eluting or Bare-Metal Stent Implantation

By Elisabetta Moscarella, Giosafat Spitaleri, Salvatore Brugaletta, Sara Sentí Farrarons, Alberto Pernigotti, Luis Ortega-Paz, Angel Cequier, Andrés Iñiguez, Antonio Serra, Pilar Jiménez-Quevedo, Vicente Mainar, Gianluca Campo, Maurizio Tespili, Peter den Heijer, Armando Bethencourt, Nicolás Vazquez, Marco Valgimigli, Patrick W. Serruys and Manel Sabaté

Abstract

Patients with high body mass index (BMI) seem to have better outcomes after percutaneous coronary intervention than normal-weight patients. However, contrasting results have been reported on the â\u80\u9cobesity paradoxâ\u80\u9d in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of our study was to investigate the impact of BMI on mortality in the population enrolled in the Evaluation of the Xience-V stent in Acute Myocardial INfArcTION (EXAMINATION) trial. The EXAMINATION trial randomized 1,498 patients with STEMI to a bare-metal stent or an everolimus-eluting stent. In this substudy patients were stratified into 3 groups according to BMI values: normal (BMI < 25 kg/m2), overweight (BMI = 25 to 29.9 kg/m2), and obese (BMI â\u89¥ 30 kg/m2). The coprimary end points were the all-cause and cardiac deaths among the groups at the 5-year follow-up. BMI was available in 1,421 patients, divided in 401 (28.2%) normal, 702 (49.4%) overweight, and 318 (22.4%) obese. Obese patients were younger (p = 0.012) compared with the other groups, but with a worse cardiovascular risk profile. They were more frequently female (p <0.001) and with a higher rate of obesity-related co-morbidity conditions such as diabetes mellitus (p = 0.005), arterial hypertension (p <0.001), and hyperlipidemia (p = 0.001) compared with the other groups. At the 5-year follow-up, all-cause and cardiac deaths were less frequent in obese patients than in the other groups (p = 0.003 and p = 0.030, respectively). After adjustment for confounding variables, BMI was an independent predictor of all-cause death (hazard ratio 0.765, 95% confidence interval 0.599 to 0.979, p = 0.033), but not of cardiac death, without any interaction with the stent type. In conclusion, in patients with STEMI who underwent primary PCI, the long-term all-cause death rate decreased as BMI increased, confirming the obesity paradox, irrespective of the stent type

Topics: Aged, Everolimus, Female, Humans, Immunosuppressive Agents, Male, Middle Aged, Obesity, Risk Factors, ST Elevation Myocardial Infarction, Self Expandable Metallic Stents, Treatment Outcome, Body Mass Index, Drug-Eluting Stents, Percutaneous Coronary Intervention, Cardiology and Cardiovascular Medicine
Year: 2017
DOI identifier: 10.1016/j.amjcard.2017.07.040
OAI identifier: oai:iris.unife.it:11392/2384649
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