1. Impact of Body Composition Indices on Ten-year Mortality After Revascularization of Complex Coronary Artery Disease (From the Syntax Extended Survival Trial)
- Author
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Yoshinobu Onuma, Mohr W. Friedrich, Hideyuki Kawashima, Daniel J F M Thuijs, Rutao Wang, David R. Holmes, Kuniaki Takahashi, Neil O'Leary, Chao Gao, Thilo Noack, Marie Claude Morice, Masafumi Ono, Stuart J. Head, Hironori Hara, Jan J. Piek, Michael J. Mack, Joanna J. Wykrzykowska, John W. McEvoy, Patrick W. Serruys, Arie Pieter Kappetein, Piroze M. Davierwala, Cardiothoracic Surgery, Graduate School, Cardiology, ACS - Heart failure & arrhythmias, ACS - Atherosclerosis & ischemic syndromes, and ACS - Microcirculation
- Subjects
Male ,medicine.medical_specialty ,Waist ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Body Mass Index ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,Obesity ,030212 general & internal medicine ,Coronary Artery Bypass ,Mortality ,Aged ,Proportional Hazards Models ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,Middle Aged ,Prognosis ,medicine.disease ,Confidence interval ,Body Composition ,Cardiology ,Female ,Waist Circumference ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Obesity paradox - Abstract
Numerous studies have demonstrated a paradoxical association between higher baseline body mass index (BMI) and lower long-term mortality risk after coronary revascularization, known as the “obesity paradox”, possibly relying on the single use of BMI. The current study is a post-hoc analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the SYNTAX trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with left-main coronary artery disease (LMCAD) or three-vessel disease (3VD). Patients were stratified according to baseline BMI and/or waist circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%) had available baseline BMI and WC data, respectively. Of those, 1,327 (73.8%) patients had High BMI (≥25 kg/m2), whereas 705 (44.4%) patients had High WC (>102 cm for men or >88 cm for women). When stratified by both BMI and WC, 10-year mortality risk was significantly higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59; 95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In conclusion, the “obesity paradox” following coronary revascularization would be driven by low long-term mortality risk of the High BMI/Low WC group. Body composition should be assessed by the combination of BMI and WC in the appropriate evaluation of the long-term risk of obesity in patients with LMCAD or 3VD.
- Published
- 2021