PT  - JOURNAL ARTICLE
AU  - Schenkeveld, Lisanne
AU  - Magro, Michael
AU  - Oemrawsingh, Rohit M
AU  - Lenzen, Mattie
AU  - de Jaegere, Peter
AU  - van Geuns, Robert-Jan
AU  - Serruys, Patrick W
AU  - van Domburg, Ron T
TI  - The influence of optimal medical treatment on the ‘obesity paradox’, body mass index and long-term mortality in patients treated with percutaneous coronary intervention: a prospective cohort study
AID  - 10.1136/bmjopen-2011-000535
DP  - 2012 Jan 01
TA  - BMJ Open
PG  - e000535
VI  - 2
IP  - 1
4099  - http://bmjopen.bmj.com/content/2/1/e000535.short
4100  - http://bmjopen.bmj.com/content/2/1/e000535.full
SO  - BMJ Open2012 Jan 01; 2
AB  - Objective To assess whether the obesity paradox persists in the long term and to study the effect of optimal medical treatment on this phenomenon.Design A retrospective cohort study.Setting A tertiary care centre in Rotterdam.Participants From January 2000 to December 2005, 6332 patients undergoing percutaneous coronary intervention for coronary artery disease were categorised into underweight (body mass index (BMI)<18.5), normal (18.5–24.9), overweight (25–29.9) and obese (>30).Primary outcome measure Mortality.Secondary outcome measures Cardiac death and non-fatal myocardial infarction.Results Optimal medical treatment was more common in obese patients as compared with normal weight patients (85% vs 76%; p<0.001). At a mean of 6.1 years, overweight and obese patients had a lower risk of all-cause mortality (HR: 0.75, 95% CI 0.66 to 0.86 and HR: 0.72, 95% CI 0.60 to 0.87, respectively). After adjusting for OMT in the multivariate analysis, BMI did not remain an independent predictor of long-term mortality (HR: 0.90, 95% CI 0.72 to 1.12 and HR: 1.07, 95% CI: 0.80 to 1.43, respectively).Conclusion BMI is inversely related to long-term mortality in patients treated with percutaneous coronary intervention. Patients with a normal BMI are on suboptimal medical treatment when compared with those with a high BMI. A more optimal medical treatment in the obese group may explain the observed improved outcome in these patients.