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Ho JSY, Soh RYH, Djohan AH, Sim HW, Loh PH, Yeo TC, Tan HC, Chan MY, Sia CH. Association of body mass index with long-term outcomes after elective and semi-urgent percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While obesity is associated with cardiovascular mortality and morbidity, patients with higher body mass index (BMI) may have better outcomes post-percutaneous coronary intervention (PCI). This “obesity paradox” is controversial and needs clarification.
Purpose
We aimed to investigate the relationship between BMI and outcomes post-PCI in an Asian cohort.
Methods
A retrospective cohort study was performed on consecutive patients who underwent semi-urgent PCI for non-ST elevation myocardial infraction or unstable angina, and elective PCI for stable angina from January 2014 to December 2015 in a tertiary centre. Patients were underweight (BMI <18.5), normal weight (BMI 18.5–22.9), overweight (BMI 23–24.9), pre-obese (BMI 25–29.9) or obese (BMI ≥30), according to the WHO Asian classification. The primary endpoint was all-cause mortality. The secondary outcomes were subsequent events of stroke or transient ischemic attack, myocardial infarction (MI) and congestive cardiac failure (CCF).
Results
1,610 patients were followed up for 3.71 (±0.97) years, 19.7% were female and mean age was 62.1 years (Table 1). BMI showed a U-shaped relationship with the incidence of death (p<0.001), MI (p=0.005), and CCF (p<0.001) (Figure 1A), which was also shown on Kaplan Meier analysis (Figures 1B-E). With reference to normal weight patients on multivariable Cox analysis, overweight (adjusted HR 0.64, 95% CI 0.42–0.97) and pre-obese (adjusted HR 0.55, 95% CI 0.38–0.80) patients had lower mortality. Underweight patients had higher risk (adjusted HR 2.12, 95% CI 1.01–4.46), while pre-obese patients had lower risk of MI (adjusted HR 0.56, 95% CI 0.34–0.92) compared to normal weight patients. Underweight and obese patients had higher risk of CCF (underweight: adjusted HR 3.05, 95% CI 1.45–6.42; obese: adjusted HR 1.86, 95% CI 1.03–3.35) compared to normal weight patients.
Conclusion
Patients at the lower and upper extremes of BMI demonstrated higher risk of mortality, MI and CCF post-PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J S Y Ho
- Royal Free London NHS Foundation Trust , London , United Kingdom
| | - R Y H Soh
- National University Heart Centre , Singapore , Singapore
| | - A H Djohan
- National University Heart Centre , Singapore , Singapore
| | - H W Sim
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - C H Sia
- National University Heart Centre , Singapore , Singapore
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Lin NH, Ho JSY, Djohan AH, Ho VWT, Teo YN, Teo YH, Syn NL, Aye YN, Soh RYH, Yeo TC, Sim HW, Tan HC, Chan MY, Sia CH. Percutaneous coronary intervention in patients aged 80 years old and above: a systematic review and meta-analysis. AsiaIntervention 2022; 8:123-131. [PMID: 36483276 PMCID: PMC9706774 DOI: 10.4244/aij-d-21-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ischaemic heart disease remains the main cause of death in the world. With increasing age, frailty and comorbidities, senior patients aged 80 years old and above who undergo percutaneous coronary intervention (PCI) are at higher risk of mortality and other complications. AIMS We aimed to examine the overall outcomes for this group of patients. METHODS Four databases (PUBMED, EMBASE, SCOPUS and CENTRAL) were searched. Studies with patients aged 80 years old and above who underwent PCI for all indications were included. Pooled outcomes of all-cause death, cardiac death, in-hospital death, subsequent stroke/transient ischaemic attack (TIA), subsequent myocardial infarction (MI), subsequent congestive cardiac failure (CCF), and overall major adverse cardiac events (MACE) were obtained for meta-analysis. RESULTS From 2,566,004 patients, the pooled cumulative incidence of death was 19.22%, cardiac death was 7.78%, in-hospital death was 7.16%, subsequent stroke/TIA was 1.54%, subsequent MI was 3.58%, subsequent CCF was 4.74%, and MACE was 17.51%. The mortality rate of all patients was high when followed up for 3 years (33.27%). ST-elevation myocardial infarction patients had more outcomes of in-hospital death (14.24% vs 4.89%), stroke/TIA (1.93% vs 0.12%), MI (3.68 vs 1.55%) and 1-year mortality (26.16% vs 13.62%), when compared to non-ST-elevation myocardial infarction patients. CONCLUSIONS There was a high mortality rate at 1 year and 3 years post-PCI in the overall population of senior patients aged 80 years old and above, regardless of indication. This necessitates further studies to explore the implications of these observations.
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Affiliation(s)
- Norman H Lin
- Department of Cardiology, National University Heart Centre, Singapore
| | - Jamie S-Y Ho
- Academic Foundation Programme, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Vanda Wen-Teng Ho
- Division of Geriatric Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yin Nwe Aye
- Department of Cardiology, National University Heart Centre, Singapore
| | - Rodney Y H Soh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui-Wen Sim
- Department of Cardiology, National University Heart Centre, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Koh KK, Wang YX, Chang ZY, Kaur H, Soh RYH, Kasunuran-Cruz MT, Soong JTY. Abdominal Swelling and Distension: An Unusual Cause of 'Ascites'. Am J Med 2021; 134:1368-1370. [PMID: 34197783 DOI: 10.1016/j.amjmed.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kylynn K Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y X Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Z Y Chang
- National University Hospital, Singapore
| | - H Kaur
- National University Hospital, Singapore
| | - R Y H Soh
- National University Hospital, Singapore
| | | | - John T Y Soong
- National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Imperial College London, United Kingdom.
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