Outcome of Peripheral Artery Disease Patients with Low Body Mass Index and Undergoing Peripheral Endovascular Intervention

Background:
Low body mass index (BMI) is a maker of frailty and associated with worse outcome. We sought to investigate in-hospital outcomes after peripheral endovascular intervention (PEI) in low BMI patients with severe peripheral artery disease (PAD) compared to those with normal BMI.

Methods:
Using NIS database between 2002 and 2014, we identified all patients who are ≥18 years of age and underwent PEI. PEI was defined as angioplasty, atherectomy, and/or stenting of lower limb vessels. After excluding individuals with BMI > 24, we used ICD-9 codes to identify normal weight (BMI 19-24) and underweight (BMI < 19) patients. All patients in both groups were matched in 1:1 Propensity score matching analysis using nearest neighbor method.

Results:
Of 2,614 patients who underwent PEI from 2002 to 2014, 807 had normal BMI (31%), and 1,807 had low BMI (69%). Patients with low BMI had higher incidence of in-hospital mortality (4.8% vs 1.2%, p< 0.001), major adverse cardiovascular events (composite of death, myocardial infarction, or stroke) (7.9% vs 4.1%, p= 0.003),open bypass surgery (9.1% vs 6.0%, p= 0.03),and infection (14.6% vs 10.5%, p= 0.02), compared with normal BMI group. There was no significant difference in the incidence of vascular complications (p= 0.31), major bleeding (p= 0.17), major amputation (p= 0.35), oracute kidney injury (p= 0.09) between low and normal BMI groups.

Conclusions:
Low BMI patients with PAD have worse in-hospital survival and adverse outcomes after PEI.