Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data

Byung Gyu Kim, Sung Jin Hong, Byeong Keuk Kim, Chul Min Ahn, Dong Ho Shin, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background and aims: It is unclear whether the obesity paradox is still apparent in the new-generation drug-eluting stent (DES) era. Therefore, we assessed the impact of body mass index (BMI) on clinical outcome after percutaneous coronary intervention (PCI) with new-generation DESs. Methods: A total of 5264 consecutive patients from 4 new-generation DES registries were divided into 4 categories according to BMI: 1) underweight (BMI<18.5 kg/m2, n = 130), 2) normal weight (18.5 ≤ BMI <25 kg/m2, n = 2943), 3) overweight (25 ≤ BMI<30 kg/m2, n = 1932), and 4) obese (BMI≥30 kg/m2, n = 259). The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular event (MACCE) at 12 months, including all-cause mortality, nonfatal myocardial infarction, stroke, and target-vessel revascularization. Results: The 12-month MACCE rates decreased according to increasing BMI categories. (underweight, 13.1%; normal, 6.0%; overweight, 4.8%; obese, 4.2%; p < 0.001). After adjustment for other confounders, the underweight group had significantly higher MACCE rates than the normal-weight (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.33–0.99; p = 0.049), overweight (HR, 0.49; 95% CI, 0.27–0.88; p = 0.017), and obese (HR, 0.41; 95% CI, 0.18–0.98; p = 0.044) groups. These differences were mainly driven by all-cause mortality and target-vessel revascularization. When BMI was treated as a continuous variable, BMI per 1 kg/m2 was also an independent predictor for MACCE (HR, 0.95; 95% CI, 0.91–0.99; p = 0.008) and a MACE increase began below a BMI of 24 kg/m2. Conclusions: Lower BMI was significantly associated with higher rates of MACCE and all-cause mortality after PCI. The obesity paradox is manifested in Korean patients in the new-generation DES era.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
Publication statusPublished - 2018 Oct

Bibliographical note

Funding Information:
This study was supported by a grant from the Korea Healthcare Technology Research and Development Project , Ministry for Health and Welfare, Republic of Korea (Nos. A085136 and HI15C1277 ); the Mid-Career Researcher Program through an NRF grant funded by the MEST, Republic of Korea (No. 2015R1A2A2A01002731 ); and the Cardiovascular Research Center, Seoul, Republic of Korea .

Publisher Copyright:
© 2018 Elsevier B.V.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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