Coronary artery disease
Impact of body mass index on the outcome of patients with multivessel disease randomized to either coronary artery bypass grafting or stenting in the ARTS trial: The obesity paradox II?

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The effect of body mass index (BMI) on outcomes after coronary artery revascularization remains controversial. We studied 1,203 patients who had multivessel coronary artery disease and underwent stenting (n = 599) or coronary artery bypass grafting (CABG; n = 604) in the Arterial Revascularization Therapies Study. Patients were assigned to 1 of 3 groups according to BMI: <25, 25 to 30, and >30 kg/m2. At 3-year follow-up, the incidence of death, cerebrovascular events, or myocardial infarction was similar for these BMI categories regardless of the revascularization technique used. Rates of repeat revascularization procedures were significantly higher among patients who had been randomized to stenting but were similar across BMI groups. For patients who had been randomized to undergo CABG, there was a significant decrease in repeat revascularization procedures in obese patients (p = 0.03). Among patients who underwent stenting, BMI had no effect on the 3-year combined end point of rate of major adverse cardiac or cerebrovascular events. Among patients who underwent CABG, major adverse cardiac or cerebrovascular event rates were significantly lower for patients who were obese (11%) or overweight (16%) compared with patients who had a normal BMI (24%; p = 0.008). Thus, in a large cohort of patients who had multivessel coronary artery disease and underwent surgical or percutaneous revascularization, BMI had no effect on 3-year outcome of those who underwent stenting. Conversely, among patients who underwent CABG, those who were overweight or obese had a significantly better outcome than did those who had a normal BMI with regard to survival without major adverse cardiac or cerebrovascular events, mainly due to lower rates of repeat revascularization procedures.

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Study design

A total of 1,205 patients who had multivessel coronary artery disease and considered equally treatable with the 2 modalities were randomized to stenting (n = 600) or CABG (n = 605) between April 1997 and June 1998 at 67 participating centers worldwide as part of the ARTS trial. Details of this study have been described previously.12, 13 In brief, patients who had not had a previous revascularization procedure were included in the study. Inclusion criteria included stable or unstable angina,

Clinical and angiographic characteristics of patients

Data on 1,203 consecutive patients who underwent PCI were available for complete analysis (2 patients did not have complete data for calculation of BMI). Fifty percent of patients were overweight and 72% were overweight or obese, with only 28% having a normal BMI in the 2 study arms. Baseline clinical characteristics of all patients are presented in Table 1, and angiographic and periprocedural characteristics are listed in Table 2.

Clinical outcomes

Three-year clinical outcomes for all BMI groups are presented in

Discussion

In this study, we analyzed the effect of BMI on 3-year outcomes of a large cohort of patients who had multivessel coronary disease and were randomized to percutaneous revascularization with stents or CABG as part of the ARTS trial. We observed that patients who had a normal BMI (<24.9 kg/m2) had similar survival rates without major adverse cardiac or cerebrovascular events (including death, cerebrovascular events, myocardial infarction, or repeat revascularization) regardless of type of

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