Catheterization and Cardiovascular Interventions

ORIGINAL ARTICLE - CLINICAL SCIENCE

Prognostic impact of in-stent restenosis in normal weight, overweight, and obese patients undergoing percutaneous coronary intervention

Davis Jones MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

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Alessandro Spirito MD,

Alessandro Spirito MD

orcid.org/0000-0002-7473-6577

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Samantha Sartori PhD,

Samantha Sartori PhD

orcid.org/0000-0003-0618-9409

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Birgit Vogel MD,

Birgit Vogel MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Madison Edens MD,

Madison Edens MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Karim Kamaleldin MD,

Karim Kamaleldin MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Brunna Pileggi MD,

Brunna Pileggi MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil

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Usman Baber MD, MS,

Usman Baber MD, MS

Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

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George Dangas MD, PhD,

George Dangas MD, PhD

orcid.org/0000-0001-7502-8049

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Samin K. Sharma MD,

Samin K. Sharma MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Annapoorna Kini MD,

Annapoorna Kini MD

orcid.org/0000-0002-7189-3307

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Roxana Mehran MD,

Corresponding Author

Roxana Mehran MD

[email protected]

orcid.org/0000-0002-5546-262X

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Correspondence Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Pl, Box 1030, New York, NY 10029-6574, USA.

Email: [email protected]

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Davis Jones MD,

Davis Jones MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

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Alessandro Spirito MD,

Alessandro Spirito MD

orcid.org/0000-0002-7473-6577

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Samantha Sartori PhD,

Samantha Sartori PhD

orcid.org/0000-0003-0618-9409

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Birgit Vogel MD,

Birgit Vogel MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Madison Edens MD,

Madison Edens MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Karim Kamaleldin MD,

Karim Kamaleldin MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Brunna Pileggi MD,

Brunna Pileggi MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil

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Usman Baber MD, MS,

Usman Baber MD, MS

Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

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George Dangas MD, PhD,

George Dangas MD, PhD

orcid.org/0000-0001-7502-8049

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Samin K. Sharma MD,

Samin K. Sharma MD

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Annapoorna Kini MD,

Annapoorna Kini MD

orcid.org/0000-0002-7189-3307

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

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Roxana Mehran MD,

Corresponding Author

Roxana Mehran MD

[email protected]

orcid.org/0000-0002-5546-262X

Icahn School of Medicine at Mount Sinai, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA

Email: [email protected]

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First published: 03 January 2024

https://doi.org/10.1002/ccd.30939

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Abstract

Background

Among patients undergoing percutaneous coronary intervention (PCI), in-stent restenosis (ISR) is related with a worse prognosis, while higher body mass index (BMI) values are associated with better outcomes. It is unclear whether the prognostic impact of ISR varies in function of BMI.

Methods

Patients undergoing PCI at a large center from 2012 to 2019 not presenting with an acute myocardial infarction (MI) were included. Subjects with BMI < 18.5 kg/m² or treated with bare metal stents were excluded. Patients were stratified according to type of lesion treated (ISR vs. no-ISR) and into four BMI categories: normal weight (BMI 18.5–25 kg/m²), overweight (25.0–29.9 kg/m²), class I obesity (30.0–34.9 kg/m²), class II–III obesity (≥35.0 kg/m²). The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, MI, and target vessel revascularization (TVR) at 1 year.

Results

Out of 16,234 patients, 3694 (23%) underwent PCI for ISR. ISR as compared to no-ISR was associated with a consistent increased risk of MACE within the normal weight (18.8% vs. 7.8%, adj. hazard ratio (HR): 1.99, 95% confidence interval [CI]: 1.51–2.64), overweight (19.1% vs. 6.4%, adj. HR: 2.35, 95% CI: 1.91–2.88), class I obesity (18.3% vs. 6.8%, adj. HR: 1.95, 95% CI: 1.47–2.57), and class II–III obesity (16.4% vs. 7.4%, adj. HR: 1.61, 95% CI: 1.09–2.37) groups (interaction p-value: 0.192). The ISR-related risks were mostly driven by an excess of TVR.

Conclusions

At 1 year, ISR was associated with an increased risk of MACE irrespective of BMI, mostly due to an excess of TVR after ISR.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Supporting Information

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Volume103, Issue2

February 1, 2024

Pages 260-267

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Prognostic impact of in-stent restenosis in normal weight, overweight, and obese patients undergoing percutaneous coronary intervention

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

References

Information

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Prognostic impact of in-stent restenosis in normal weight, overweight, and obese patients undergoing percutaneous coronary intervention

Abstract

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

References

Related

Information