Low body mass index is associated with adverse cardiovascular outcomes following PCI in India: ACC-NCDR registry

Rajeev Gupta, Krishna Kumar Sharma, Raghubir Singh Khedar, Sanjeev Kumar Sharma, Jitender Singh Makkar, Ajeet Bana, Vishnu Natani, Shilpa Bharati, Sumit Kumar, Vishal Hadiya, Sailesh Lodha, Samin Kumar Sharma

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Objective: Registry-based prospective study was conducted to evaluate association of body mass index (BMI) with major adverse coronary events (MACE) following percutaneous coronary intervention (PCI). Methods: Successive patients undergoing PCI were enrolled from April‘19 to March’22 and classified into five BMI categories (<23.0,23.0-24.9,25.0-26.9,27.0–29.9, and ≥30.0 kg/m2). Clinical, angiographic features, interventions and outcomes were obtained by in-person or telephonic follow-up. Primary endpoints were (a) MACE(cardiovascular deaths, acute coronary syndrome or stroke, revascularization, hospitalization and all-cause deaths) and (b)cardiovascular deaths. Cox-proportionate hazard ratios(HR) and 95 % confidence intervals(CI) were calculated. Results: The cohort included 4045 patients. Mean age was 60.3 ± 11y, 3233(79.7 %) were men. There was high prevalence of cardiometabolic risk factors. 90 % patients had acute coronary syndrome(STEMI 39.6 %, NSTEMI/unstable angina 60.3 %), 60.0 % had impaired ejection fraction(EF) and multivessel CAD. Lower BMI groups (<23.0 kg/m2) had higher prevalence of tobacco use, reduced ejection fraction(EF), multivessel CAD, stents, and less primary PCI for STEMI. There was no difference in discharge medications and in-hospital deaths. Median follow-up was 24 months (IQR 12–36), available in 3602(89.0 %). In increasing BMI categories, respectively, MACE was in 10.9,8.9,9.5,9.1 and 6.8 % (R2 = 0.73) and CVD deaths in 5.1,4.5,4.4,5.1 and 3.5 % (R2 = 0.39). Compared to lowest BMI category, age-sex adjusted HR in successive groups for MACE were 0.89,0.87,0.79,0.69 and CVD deaths 0.98,0.87,0.95,0.75 with overlapping CI. HR attenuated following multivariate adjustments. Conclusions: Low BMI patients have higher incidence of major adverse cardiovascular events following PCI in India. These patients are older, with greater tobacco use, lower EF, multivessel CAD, delayed STEMI-PCI, and longer hospitalization.

Original languageEnglish
Article number200230
JournalInternational Journal of Cardiology: Cardiovascular Risk and Prevention
StatePublished - Mar 2024


  • Body mass index
  • Cardiovascular deaths
  • Coronary angioplasty
  • Coronary artery disease
  • Frailty
  • Major adverse cardiovascular events


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