Obesity paradox in patients undergoing coronary intervention: A review

Table 1 Summary of association between percutaneous coronary intervention and obesity

Ref.	Study population	Study design	Outcome measures	Relationship with obesity
Akin et al[2]	1436 normal weight, 2839 overweight, and 1531 obese patients	Retrospective Cohort Study	Primary endpoints were the rate of major adverse cardiac and cerebrovascular events and target vessel revascularization	Baseline clinical parameters were more severe in overweight and obese patients
Angerås et al[15]	64436 patients going under angiography. Patients were divided into 9 groups based upon BMI	Cohort Study	To investigate the relationship between BMI and mortality in patients with ACSs	Obese and overweight patients have least mortality compared with normal, underweight, and morbidly obese patients
Gurm et al[14]	4 randomized, controlled trials	Systematic Review	To study the impact of BMI on outcome patients undergoing PCI	Increased BMI is associated with reduced risk of complications after PCI
Kaneko et al[11]	1205 patients: 92 lean, 640 normal-weight; 417 overweight, and 56 obese	Retrospective Cohort Study	Impact of obesity on Japanese patients who undergo primary PCI	Over-weight and obese patients were independently associated with favorable long-term clinical outcomes after PCI
Lazzeri et al[17]	1268 patients: 37 lean, 403 normal, 656 overweight, 172 obese patients	Case Series	Impact of age on the prognostic value of BMI	In patients < 75 yr, overweight patients showed increased in-hospital mortality rate and a poorer long-term survival rate
Kosuge et al[20]	3076 patients undergoing PCI	Case Control Study	In-hospital mortality	BMI itself had no impact on in-hospital mortality in patients undergoing primary PCI
Sharma et al[19]	36 studies (12 CABG; 26 PCI)	Meta-Analysis	Total mortality, CV mortality, and myocardial infarction	The risk of total mortality, CV mortality, and MI was highest among underweight patients as defined by low BMI and CV mortality was lowest among overweight patients
Stähli et al[9]	1993 patients: 461 (23.1%) were of normal weight, 985 (49.4%) overweight, 396 (19.9%) obese, and 144 (7.2%) very obese	Retrospective Cohort Study	All-cause mortality	Overweight and obese patients had lower all-cause mortality
Lancefield et al[10]	4762 patients undergoing PCI	Meta-Analysis	In-hospital and 12-mo MACE and mortality rates after PCI	Overweight and obese patients had lower in-hospital and 12-mo MACE and mortality rates after PCI
Uretsky et al[5]	22576 hypertensive patients with coronary artery disease	Randomized Control Trial	Primary outcomes include first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke	Obese patients had a decreased risk of primary outcomes
Kang et al[12]	3824 STEMI patients: 129 underweight, 1253 normal weight, 1959 overweight, 483 obese	Retrospective Cohort Study	In-hospital mortality, revascularization in 1 yr, mortality in 1 yr, and overall mortality	Obese patients had significantly lower in-hospital and overall mortalities
Numasawa et al[13]	10142 patients: 462 underweight, 5945 normal, 3100 overweight and 635 obese	Retrospective Cohort Study	In-hospital outcomes	Obese patients are at a lower risk for in-hospital complications during and after PCI
Younge et al[16]	1019 patients: 354 normal, 468 overweight, and 197 obese	Prospective Cohort Study	All-cause mortality	Overweight, but not obesity, was associated with a lower risk for 7-yr mortality in PCI patients
Wang et al[21]	6083 patients (normal: 1592; overweight: 3026; obese: 1465)	Retrospective Cohort Study	Clinical-driven repeat revascularization, including TLR and non-TLR	Obesity was not associated with TLR, but was associated with a higher risk of non-TLR

ACS: Acute coronary syndrome; BMI: Body mass index; CV: Cardiovascular; CABG: Coronary artery bypass grafting; MACE: Major adverse cardiac event; PCI: Percutaneous coronary intervention; STEMI: ST- segment elevation myocardial infarction; TLR: Target lesion revascularization.