Korean Circ J.  2023 Dec;53(12):843-854. 10.4070/kcj.2023.0159.

Association Between Body Mass Index and Clinical Outcomes According to Diabetes in Patients Who Underwent Percutaneous Coronary Intervention

• Kim BG
• Hong SJ
• Kim BK
• Lee YJ
• Lee SJ
• Ahn CM
• Shin DH
• Kim JS
• Ko YG
• Choi D
• Hong MK
• Jang Y

• KMID: 2548792
• DOI: http://doi.org/10.4070/kcj.2023.0159

Abstract

Background and Objectives
We evaluated the effect of diabetes on the relationship between body mass index (BMI) and clinical outcomes in patients following percutaneous coronary intervention (PCI) with drug-eluting stent implantation.
Methods
A total of 6,688 patients who underwent PCI were selected from five different registries led by Korean Multicenter Angioplasty Team. They were categorized according to their BMI into the following groups: underweight (<18.5 kg/m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight to obese (≥25.0 kg/m 2 ). Major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, nonfatal myocardial infarction, stroke, and target-vessel revascularization, were compared according to the BMI categories (underweight, normal and overweight to obese group) and diabetic status. All subjects completed 1-year follow-up.
Results
Among the 6,688 patients, 2,561 (38%) had diabetes. The underweight group compared to normal weight group had higher 1-year MACCE rate in both non-diabetic (adjusted hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.04–4.84; p=0.039) and diabetic patients (adjusted HR, 2.86; 95% CI, 1.61–5.07; p<0.001). The overweight to obese group had a lower MACCE rate than the normal weight group in diabetic patients (adjusted HR, 0.67 [0.49–0.93]) but not in non-diabetic patients (adjusted HR, 1.06 [0.77–1.46]), with a significant interaction (p-interaction=0.025).
Conclusions
Between the underweight and normal weight groups, the association between the BMI and clinical outcomes was consistent regardless of the presence of diabetes. However, better outcomes in overweight to obese over normal weight were observed only in diabetic patients. These results suggest that the association between BMI and clinical outcomes may differ according to the diabetic status.

Keyword

Body mass index; Obesity paradox; Diabetes mellitus; Percutaneous coronary intervention

Figure

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  Figure 1 Patients’ selection. Study flow.BMI = body mass index; CONSTANT = clinical, optical coherence tomography, and angiographic outcomes following Resolute zotarolimus-eluting stent implantation for patients with or without diabetes mellitus; CPR-IMT = randomized trial comparing the effect of pravastatin and rosuvastatin on atherosclerosis progression measured by carotid intima-media thickness in patients with coronary artery disease after Biolimus-eluting stent implantation; PCI-CABG registry = clinical outcomes of percutaneous coronary intervention versus coronary artery bypass graft for multivessel disease; REVOLUTE = registry to evaluate clinical outcomes following new-generation drug-eluting stents.

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  Figure 2 Kaplan-Meier curves according to BMI categories and diabetes status.Rate of MACCE (A) and all-cause death (B) according to BMI categories and diabetes status.BMI = body mass index; CI = confidence interval; DM = diabetes mellitus; HR = hazard ratio; MACCE = major adverse cardiac and cerebrovascular event; PCI = percutaneous coronary intervention.

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  Figure 3 Association of BMI categories with clinical outcomes in diabetes and non-diabetes patients.Multivariate adjusted hazard ratio and its confidence interval for (A) MACCE and (B) all-cause mortality according to BMI categories in patients with and without diabetes. The normal weight (BMI 18.5–24.9 kg/m2) group was considered as the reference group. Adjusted for age, sex, hypertension, dyslipidemia, chronic kidney disease, smoking status, previous cerebrovascular accident, acute coronary syndrome, reduced ejection fraction, and multivessel disease.BMI = body mass index; CI = confidence interval; HR = hazard ratio; MACCE = major adverse cardiac and cerebrovascular event.*p<0.05, as compared to the reference group; **p<0.01, as compared to the reference group.

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