Obesity Paradox Still Exists After Percutaneous Coronary Intervention Independent of Metabolic Status

초록

Background: Previous studies have suggested an obesity paradox in patients with coronary artery disease. Because obese patients are also known to have multiple metabolic derangements, therefore, we aimed to investigate the impact of obesity and it’s relation with metabolic parameters on clinical outcomes in patient undergoing percutaneous coronary intervention (PCI). Methods: A total of 714 consecutive patients who underwent PCI between May 2010 and April 2011 were enrolled and divided into three groups according to body mass index (BMI): normal weight (BMI < 23.0 kg/m2, n=211), overweight (23.0 ≤ BMI < 27.5 kg/m2, n=375), and obese groups (BMI ≥ 27.5 kg/m2, n=128). Lipid profile, fasting glucose, insulin, HbA1c, and insulin sensitivity evaluated by quantitative insulin-sensitivity check index (QUICKI) were measured. Primary endpoint was 1-year major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, non-fatal myocardial infarction (MI), stroke, revascularization, or admission for heart failure. Results: The overweight or obese group had a higher incidence of hypertension, diabetes, and hyperlipidemia than the normal weight group. Left ventricular systolic dysfunction (ejection fraction < 40%) was more frequent in the normal group compared to the overweight or obese group (14.1% vs. 7.3% vs. 8.6%, p=0.026, respectively). Fasting glucose, HbA1c, LDL-cholesterol did not differ significantly between groups. However, obese group had higher levels of fasting insulin than normal weight group (12.5±13.6μU/mL vs. 8.6±12.4μU/mL, p=0.007). In addition, there was a significant difference of QUICKI between normal, overweight and obese groups (0.345±0.048 vs. 0.336±0.040 vs. 0.321±0.038, p<0.05 for each groups, respectively). The cumulative incidence of MACEs at 1 year was 15.6% for the normal group, 5.9% for the overweight group, and 3.9% for the obese group (p<0.001). Conclusions: Overweight or obese patients had better clinical outcomes compared with normal weight patients after PCI although overweight or obese patients have more metabolic abnormality.