Association of Body Mass Index on 10-Year Outcomes in Patients Treated with Percutaneous Coronary Intervention and Drug-Eluting Stents (the DECADE Cooperation).

Aim To assess the association between body mass index (BMI) and 10-year clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation.Methods This is a pooled analysis of 5 randomized trials with 10-year follow-up. All-cause death was the primary outcome. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST) and repeat revascularization.Results A total of 9,486 patients were analyzed divided into four BMI groups (underweight [n= 92], normal-weight [n= 2,785], overweight [n= 4,296] and obese [n= 2,313]). After 10 years, the risk of all-cause death was significantly higher in underweight patients than in those of normal weight (adjusted hazard ratio [HRadj], 1.58; 95% confidence interval [CI], 1.01-2.47). Compared with normal-weight patients, overweight patients had a significantly lower risk of all-cause death (HRadj, 0.84; 95% CI, 0.78-0.90) and cardiovascular death, while the difference was not significant for obese patients. Overweight and obese patients had a significantly higher risk of definite ST within 30 days, while obese patients had a significantly lower risk of TLR than normal-weight patients. There was a U-shaped, non-linear association between BMI, all-cause death and cardiovascular death.Conclusions The baseline BMI of patients undergoing PCI with DES may have important implications for long-term secondary prevention strategies. Further dedicated studies are needed to overcome the limitations of the current analysis.This pooled analysis of 9,486 patients from 5 randomized trials, examined the 10-year outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation according to the body mass index. 10-year mortality rate after PCI with DES was higher for underweight patients, lower for overweight patients, and comparable for obese patients;Overweight and obese patients showed a higher risk of definite stent thrombosis within 30 days after PCI, whereas obese patients experienced a lower risk of repeat revascularization compared to normal-weight patients.