Obesity paradox in Japanese patients after percutaneous coronary intervention: An observation cohort study

Background: The impact of obesity on Japanese patients who undergo primary percutaneous coronary intervention (PCI) remains unclear. Methods and results: Within a single hospital-based cohort in the Shinken Database 2004-2010, which comprised all new patients (n = 15 227) who visited the Cardiovascular Institute, we followed patients who underwent PCI. Major adverse cardiac events (MACE)-death, myocardial infarction, or target lesion revascularization (TLR)-were defined as the composite endpoint. A total of 1205 patients were included in this study (median follow-up of 1037 +/- 703 days): 92 lean [body-mass-index (BMI) <20]; 640 normal-weight (BMI = 20-24.9); 417 overweight (BMI = 25-29.9); and 56 obese (BMI >= 30). Mean age decreased and male gender increased with increasing BMI. Classic coronary risk factors were more common in overweight and obese patients than in normal-weight and lean patients. Chronic kidney disease (CKD) was more common in lean patients than in overweight and obese patients. Patients taking dual antiplatelet therapy, statins, beta-blockers, and renin-angiotensin-system inhibitors increased in a BMI-dependent manner. Obese patients had a significantly lower frequency of MACE, all-cause death, cardiac death, and hospital admission for heart failure than lean patients. Multivariate analysis showed that BMI category was independently associated with all-cause death after PCI. Conclusion: Over-weight and obese patients were independently associated with favorable long-term clinical outcomes after PCI, suggesting that obesity paradox was applicable to Japanese patients after PCI in real-world clinical setting. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.