Associations Between Metabolic Phenotypes and Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention: A Prospective Cohort Study

ABSTRACT

Obesity and metabolic abnormalities are risk factors for cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic impact of distinct metabolic phenotypes after percutaneous coronary intervention (PCI) remains unclear. We enrolled 23,882 patients undergoing PCI at Fuwai Hospital between 2017 and 2018. Obesity was defined as body mass index (BMI) ≥ 28.0 kg/m ² , and metabolic unhealth was defined as diabetes or hypertension plus dyslipidemia. Patients were classified into four phenotypes: metabolically healthy non‐obese (MHN), metabolically healthy obese (MHO), metabolically unhealthy non‐obese (MUN), and metabolically unhealthy obese (MUO). Primary endpoint was 3‐year CV events, including CV death, non‐fatal MI, and non‐fatal stroke. During a median follow‐up of 36 months, 757 (3.2%) CV events occurred. Compared with MHN, MUN was associated with higher CV risk (HR 1.27, 95% CI 1.07–1.52). The excess risk in MUN was mainly driven by non‐fatal MI (HR 1.47, 95% CI 1.09–1.99) and stroke (HR 1.71, 95% CI 1.07–2.75). Among metabolically unhealthy patients, non‐obese individuals had higher all‐cause mortality than obese individuals (HR 1.50, 95% CI 1.12–2.02). Metabolically unhealthy non‐obese patients had increased CV risk after PCI. Metabolic phenotype stratification may improve risk prediction in CAD patients.