Outcomes of Myocardial Revascularization in Patients with Obesity and Multivessel Coronary Artery Disease

Overview

Journal Egypt Heart J

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 28

PMID 39198363

Authors

Maira I Madiyeva

Marat A Aripov

Alexey Y Goncharov

Rakhima Y Zholdasbekova

Affiliations

Soon will be listed here.

Abstract

Background: There is uncertainty regarding the best revascularization approach-whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-for obese patients suffering from multi-vessel coronary artery disease.

Results: 406 patients with low and intermediate SYNTAX scores (SS) underwent PCI with drug-eluting stents (n = 200, 100 with SS ≤ 22, and 100 with SS 23-32) and CABG (n = 206, 100 with SS ≤ 22, and 106 with SS 23-32). Patients were also categorized by body mass index (BMI): normal weight (12%, 48 patients), overweight (41.6%, 169 patients), and obese (46.6%, 189 patients). The follow-up period averaged 9 ± 1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events, a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥ 33) observed over time. When comparing PCI and CABG in overweight individuals, the risk of myocardial infarction (MI) following PCI was greater than after CABG (Hazard Ratio [HR] 2.7, 95% Confidence Interval [CI] 1.1-6.7, p = 0.03). In patients with overweight and Class I obesity, CABG was associated with the risk of coronary atherosclerosis progression (SS ≥ 33) (HR 4.4, 95% CI 1.5-13, p = 0.009 and HR 4.9, 95% CI 1.9-12, p = 0.001, respectively); whereas PCI was connected with the likelihood of repeat revascularization (HR 2.7, 95% CI 1.6-4.55, p < 0.0001 and HR 2, 95% CI 1.3-3.1, p = 0.002, respectively). At the same time, for stented patients, Class III obesity was associated with the risk of repeat revascularization (HR 2.5, 95% CI 1.02-6, p = 0.044).

Conclusion: There were no significant weight-related impacts on long-term outcomes among patients who underwent surgery. Whereas in stented patients, Class III obesity was associated with the risk of repeat revascularization. When comparing PCI and CABG, for overweight and Class I obesity patients, CABG was associated with a likelihood of coronary atherosclerosis progression (SS ≥ 33), while PCI was linked to the risk of repeat revascularization. For overweight patients, CABG outperformed PCI in terms of the risk of MI. For other adverse events in patients of different weight categories, PCI and CABG did not reveal any significant benefits.

References

Akbari T, Al-Lamee R . Percutaneous Coronary Intervention in Multi-Vessel Disease. Cardiovasc Revasc Med. 2022; 44:80-91. DOI: 10.1016/j.carrev.2022.06.254. View

Spadaccio C, Antoniades C, Nenna A, Chung C, Will R, Chello M . Preventing treatment failures in coronary artery disease: what can we learn from the biology of in-stent restenosis, vein graft failure, and internal thoracic arteries?. Cardiovasc Res. 2019; 116(3):505-519. DOI: 10.1093/cvr/cvz214. View

Shaik T, Chaudhari S, Haider T, Rukia R, Al Barznji S, Kataria H . Comparative Effectiveness of Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention for Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Clinical Trials. Cureus. 2022; 14(9):e29505. PMC: 9588386. DOI: 10.7759/cureus.29505. View

Akin I, Tolg R, Hochadel M, Bergmann M, Khattab A, Schneider S . No evidence of "obesity paradox" after treatment with drug-eluting stents in a routine clinical practice: results from the prospective multicenter German DES.DE (German Drug-Eluting Stent) Registry. JACC Cardiovasc Interv. 2012; 5(2):162-9. DOI: 10.1016/j.jcin.2011.09.021. View

Wang Z, Gao F, Cheng W, Yang Q, Zhou Y . Body Mass Index and Repeat Revascularization After Percutaneous Coronary Intervention: A Meta-analysis. Can J Cardiol. 2015; 31(6):800-8. DOI: 10.1016/j.cjca.2015.01.031. View

Biancari F, Gudbjartsson T, Heikkinen J, Anttila V, Makikallio T, Jeppsson A . Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged≤50 years (the Coronary aRtery diseAse in younG adultS Study). Am J Cardiol. 2014; 114(2):198-205. DOI: 10.1016/j.amjcard.2014.04.025. View

Gu D, Qu J, Zhang H, Zheng Z . Revascularization for Coronary Artery Disease: Principle and Challenges. Adv Exp Med Biol. 2020; 1177:75-100. DOI: 10.1007/978-981-15-2517-9_3. View

. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024; 403(10440):2100-2132. PMC: 11126520. DOI: 10.1016/S0140-6736(24)00367-2. View

Sharma A, Vallakati A, Einstein A, Lavie C, Arbab-Zadeh A, Lopez-Jimenez F . Relationship of body mass index with total mortality, cardiovascular mortality, and myocardial infarction after coronary revascularization: evidence from a meta-analysis. Mayo Clin Proc. 2014; 89(8):1080-100. DOI: 10.1016/j.mayocp.2014.04.020. View

10.

Katta N, Loethen T, Lavie C, Alpert M . Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging. Curr Probl Cardiol. 2020; 46(3):100655. DOI: 10.1016/j.cpcardiol.2020.100655. View

11.

Ahn J, Kang D, Yun S, Hur S, Park H, Tresukosol D . Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial. Circulation. 2022; 146(21):1581-1590. DOI: 10.1161/CIRCULATIONAHA.122.062188. View

12.

Wilson P, DAgostino R, Sullivan L, Parise H, Kannel W . Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002; 162(16):1867-72. DOI: 10.1001/archinte.162.16.1867. View

13.

Tobias D, Hu F . Does being overweight really reduce mortality?. Obesity (Silver Spring). 2013; 21(9):1746-9. PMC: 3806201. DOI: 10.1002/oby.20602. View

14.

Wolny R, Maehara A, Liu Y, Zhang Z, Mintz G, Redfors B . The obesity paradox revisited: body mass index and -long-term outcomes after PCI from a large pooled patient-level database. EuroIntervention. 2019; 15(13):1199-1208. DOI: 10.4244/EIJ-D-19-00467. View

15.

Fan Y, Liu J, Jin L, Liu Z, Han L, Wang Y . Impacts of metabolic disorders on short- and long-term mortality after coronary artery surgery in the elderly. BMC Cardiovasc Disord. 2022; 22(1):504. PMC: 9700925. DOI: 10.1186/s12872-022-02954-6. View

16.

. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995; 854:1-452. View

17.

Donini L, Pinto A, Giusti A, Lenzi A, Poggiogalle E . Obesity or BMI Paradox? Beneath the Tip of the Iceberg. Front Nutr. 2020; 7:53. PMC: 7221058. DOI: 10.3389/fnut.2020.00053. View

18.

Henning R . Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: a review of the pathophysiology and treatment of obesity. Am J Cardiovasc Dis. 2021; 11(4):504-529. PMC: 8449192. View

19.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

20.

Fitzgibbon G, Kafka H, Leach A, Keon W, HOOPER G, Burton J . Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996; 28(3):616-26. DOI: 10.1016/0735-1097(96)00206-9. View