Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry

Yohei Numasawa, Shun Kosaka, Hiroaki Miyata, Akio Kawamura, Shigetaka Noma, Masahiro Suzuki, Susumu Nakagawa, Yukihiko Momiyama, Kotaro Naito, Keiichi Fukuda

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Abstract

Background: Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations. Methods: We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥18.5 and <25.0 (n=5,945); overweight, BMI ≥25.0 and <30.0 (n=3,100); and obese, BMI ≥30.0 (n=635). Results: Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment bymultivariate logistic regression analysis (odds ratio, 0.95; 95%confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95%CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95%CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95%CI, 0.88-1.01; p=0.091). Conclusions: Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.

Original languageEnglish
Article numbere0124399
JournalPLoS One
Volume10
Issue number4
DOIs
Publication statusPublished - 2015 Apr 14

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Percutaneous Coronary Intervention
body mass index
Registries
Body Mass Index
underweight
hemorrhage
Thinness
Hemorrhage
Cardiogenic Shock
Medical problems
Regression analysis
Hospital Mortality
Logistics
Blood
obesity
Obesity
Social Adjustment
blood transfusion
hyperlipidemia
diabetes mellitus

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry. / Numasawa, Yohei; Kosaka, Shun; Miyata, Hiroaki; Kawamura, Akio; Noma, Shigetaka; Suzuki, Masahiro; Nakagawa, Susumu; Momiyama, Yukihiko; Naito, Kotaro; Fukuda, Keiichi.

In: PLoS One, Vol. 10, No. 4, e0124399, 14.04.2015.

Research output: Contribution to journalArticle

Numasawa, Yohei ; Kosaka, Shun ; Miyata, Hiroaki ; Kawamura, Akio ; Noma, Shigetaka ; Suzuki, Masahiro ; Nakagawa, Susumu ; Momiyama, Yukihiko ; Naito, Kotaro ; Fukuda, Keiichi. / Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry. In: PLoS One. 2015 ; Vol. 10, No. 4.
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author = "Yohei Numasawa and Shun Kosaka and Hiroaki Miyata and Akio Kawamura and Shigetaka Noma and Masahiro Suzuki and Susumu Nakagawa and Yukihiko Momiyama and Kotaro Naito and Keiichi Fukuda",
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T1 - Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry

AU - Numasawa, Yohei

AU - Kosaka, Shun

AU - Miyata, Hiroaki

AU - Kawamura, Akio

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Nakagawa, Susumu

AU - Momiyama, Yukihiko

AU - Naito, Kotaro

AU - Fukuda, Keiichi

PY - 2015/4/14

Y1 - 2015/4/14

N2 - Background: Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations. Methods: We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥18.5 and <25.0 (n=5,945); overweight, BMI ≥25.0 and <30.0 (n=3,100); and obese, BMI ≥30.0 (n=635). Results: Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment bymultivariate logistic regression analysis (odds ratio, 0.95; 95%confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95%CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95%CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95%CI, 0.88-1.01; p=0.091). Conclusions: Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.

AB - Background: Obesity is associated with advanced cardiovascular disease. However, some studies have reported the "obesity paradox" after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations. Methods: We studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥18.5 and <25.0 (n=5,945); overweight, BMI ≥25.0 and <30.0 (n=3,100); and obese, BMI ≥30.0 (n=635). Results: Patients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment bymultivariate logistic regression analysis (odds ratio, 0.95; 95%confidence interval, 0.92-0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95%CI, 0.95-0.99; p=0.033) and bleeding complications (OR, 0.95; 95%CI, 0.91-0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95%CI, 0.88-1.01; p=0.091). Conclusions: Lean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.

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