Background Obesity is a major risk factor for developing coronary artery disease. It is less clear whether obesity accelerates progression of disease among those with established coronary disease.

Objective To evaluate the effect of obesity on repeat revascularization for target and nontarget lesions in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Methods We studied 4,972 patients between January 2004 and December 2006. Patients were divided into three groups according to body mass index (BMI): normal (BMI 30 kg/m², n=1, 213). Median follow-up was 26 (IR 20–33) months.

Results There was no significant difference in the cumulative incidence of target lesion revascularisation (TLR) among normal-weight, overweight and obese patients (6.8% vs 5.4% vs 6.3%; p=0.186). In contrast, the incidence of nontarget lesion revascularisation (nonTLR) was significantly higher in obese patients compared with normal-weight and overweight populations (8.6% vs 5.9% vs 5.7%; p=0.001). Multivariate analysis showed that obesity was independently associated with a higher risk of nonTLR in patients without statins treatment (HR 1.53; 95% CI 1.03 to 2.28; p=0.037), but not in patients with concomitant statins treatment (HR 1.29; 95% CI 0.82 to 2.03; p=0.263).

Conclusions Among patients undergoing PCI with DES, obesity was not associated with TLR, but was associated with a higher risk of nonTLR. Statins use may attenuate this adverse effect of obesity on atherosclerotic progression.