Abstract 12908: Effects of Metabolic Syndrome on In-Stent Restenosis After PCI: Obesity Paradox and Sex-Associated Differences

Abstract

Background: The impact of metabolic syndrome (MetS) on the efficacy of PCI remains controversial. Hypothesis: This controversy may be due in part to a positive influence of obesity (the “obesity paradox”) among the factors included in the definition of MetS. Fat distribution also varies by sex, possibly confounding the impact of obesity. Methods: To elucidate the possible effects of obesity in MetS patients on in-stent restenosis (ISR) or target lesion revascularization (TLR), 546 patients treated with coronary stents (BMS or DES) were stratified according to the presence of MetS with or without obesity, using NCEP-ATP III guidelines. Waist circumference or BMI (in patients without waist circumference data) was used for diagnosis of obesity. Follow-up angiography was scheduled 8 to 9 months after PCI to obtain ISR, which was defined as %diameter stenosis (%DS)>50%. Results: Mean age of the subjects was 70.5±9.8 years, and 32.1% were female. By standard criteria, 286 patients (52.4%) were diagnosed as MetS, and 320 patients (58.6%) met criteria for obesity. Among MetS patients, 61 patients (21.3% of MetS patients) were categorized as non-obesity. At 8 to 9 months follow-up, % DS, ISR rates, and TLR rates had trends to be higher in MetS than no-MetS (ISR; 26.6% in MetS, 20.0% in non-MetS, p=0.085). These parameters showed no difference between obesity and non-obesity (ISR; 23.8% in obesity, 23.0% in non- obesity, p=0.918, TLR; 14.1% in obesity, 15.0% in non-obesity, p=0.805). In patients with MetS (Figure), however, the ratio of %DS and ISR were significantly greater in the absence of obesity in female patients, whereas no difference was observed in male patients. In multivariate analysis, non-obesity was an independent predictor for ISR or TLR in female patients with MetS. Conclusions: Overall, obesity was not related to ISR or TLR after PCI. In female MetS patients, however, comorbidity of obesity appeared to be paradoxically protective.