Effect of obesity on coronary atherosclerosis and outcomes of percutaneous coronary intervention: grayscale and virtual histology intravascular ultrasound substudy of assessment of dual antiplatelet therapy with drug-eluting stents

Circ Cardiovasc Interv. 2014 Dec 31;8(1):e001392. doi: 10.1161/CIRCINTERVENTIONS.114.001392. Print 2015 Jan.

Abstract

Background: Obesity is a cardiovascular risk factor, but the obesity paradox in patients undergoing percutaneous coronary intervention is poorly understood.

Methods and results: Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter study of patients undergoing drug-eluting stent implantation. Overall, 780 patients (916 culprit lesions) were evaluated by grayscale and virtual histology-intravascular ultrasound pre-percutaneous coronary intervention. Poststenting intravascular ultrasound was done in 780 patients (894 treated lesions). Patients were divided into body mass index (BMI) tertiles. The high-BMI group had more diabetes mellitus, hypertension, and hyperlipidemia and more frequent plaque ruptures compared with the low-BMI group. At the minimal lumen area site, the high-BMI group had a larger plaque area (11.7 [11.0-12.4] versus 9.8 [9.3-10.4] mm(2)) and a greater plaque burden (77.3% [76.1%-78.5%] versus 74.4% [73.1%-75.8%]) compared with the low-BMI group; however, a larger external elastic membrane area (14.6 [13.8-15.3] versus 12.7 [12.1-13.3] mm(2)) resulted in a similar minimal lumen area compared with the low-BMI group. Post stenting, the high-BMI group had a significantly larger stent area versus the lower-BMI group. At 1-year follow-up, the high-BMI group was associated with less clinically driven target lesion revascularization compared with the low-BMI group in both the overall and the propensity-matched cohorts.

Conclusions: A high BMI was associated with a greater plaque burden; however, a larger external elastic membrane preserved lumen dimensions and was associated with a larger stent area during intravascular ultrasound-guided stent implantation. Thus, despite more comorbidities, greater plaque burden, and more plaque rupture, a high BMI was not associated with worse outcomes after drug-eluting stent implantation.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.

Keywords: atherosclerosis; obesity.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Vessel Prosthesis Implantation*
  • Body Mass Index
  • Comorbidity
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy
  • Coronary Thrombosis / etiology
  • Coronary Thrombosis / prevention & control*
  • Coronary Vessels / pathology
  • Coronary Vessels / surgery*
  • Drug-Eluting Stents / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Obesity / mortality
  • Obesity / therapy
  • Paclitaxel
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Ultrasonography, Interventional / methods
  • United States

Substances

  • Platelet Aggregation Inhibitors
  • Paclitaxel

Associated data

  • ClinicalTrials.gov/NCT00638794