The relationship of obesity to ischemic outcomes following coronary stent placement in contemporary practice

Objectives : We analyzed the relationship of obesity, determined by body mass index (BMI), to short‐ and long‐term outcomes in the TARGET trial. BACKGROUND: Previous studies have conflicting findings regarding the relationship of BMI to outcomes following percutaneous coronary intervention (PCI).Methods : The TARGET trial studied the use of glycoprotein (GP) IIb/IIIa inhibition in patients undergoing planned coronary stent placement.Results : Eighty‐one percent of all patients were overweight (BMI > 25), 36% were obese (BMI > 30), and United States patients were more frequently obese (38.7% vs. 25.8%, P < 0.001). Obese patients had a similar 30‐day ischemic event rate compared with nonobese patients, but less major bleeding (0.4% vs. 1.1%, P = 0.013). Six‐month death and myocardial infarction rates were similar in obese and nonobese patients. There was a J‐shaped relationship between 6‐month target vessel revascularization (TVR) and BMI with the lowest incidence of TVR at BMI 27.5. Six‐month TVR was higher in the morbidly (BMI > 35) obese (12.4% vs 8.7%, P < 0.05). In extremely (BMI > 32) obese patients, this relationship was more significant (TVR 11.3% vs. 8.5%, P = 0.007), particularly in patients <65 years of age (TVR 12.3% vs. 8.4%, P = 0.003).Conclusion : The majority of patients undergoing PCI are overweight, especially in the United States. Extreme obesity is associated with a significant increase in TVR following intent‐to‐stent PCI, especially in patients <65 years of age. With routine use of GP IIb/IIIa inhibitors, other long‐ and short‐term ischemic events are similar in obese and nonobese patients. However, obese patients have significantly less major bleeding. © 2006 Wiley‐Liss, Inc.