Abstract 11189: Obesity is Associated with Better Intra-Hospital Outcome in Diabetes Patients Hospitalized for Stemi: Findings from the National Inpatient Sample

Abstract

Introduction: An obesity paradox is observed in patients with diabetes. Hypothesis: We hypothesized that obese patients with diabetes hospitalized for STEMI have a better intra-hospital outcome. Methods: We used data from the National Inpatient Sample (NIS) from 2008 to 2014. Patients with STEMI and diabetes were classified according to their BMI: Underweight (BMI <19), Normal (BMI 19-24.9), Class I Obesity (BMI 25.0-29.9), Class II Obesity (BMI 30.0-39.9), and Class III Obesity (BMI >40). We compared different classes and assessed in-hospital events. Results: 1.7% patients were underweight, 3.0% had normal weight, 10.4% had Obesity Class I, 54.8% had Obesity Class II, and 30.2% had Obesity Class III. Mean age (SD) was higher in underweight patients (73 ±13) but decreases progressively to reach 58 ± 11 in class III obesity (p<0.001). There were more females in underweight patients and more males in normal weight and obese patients (p<0.001). Obese patients had a significantly lower risk compared to normal weight patients, but not underweight (Figure 1). In cardiogenic shock, underweight and class I obese patients had a similar risk compared to normal weight, but class II (a OR= 0.53 [0.40-0.70]) and class III (OR=0.62 [0.46 - 0.82] had a lower risk. The risk of ventricular fibrillation was not different according to groups. Interestingly, the risk of atrial fibrillation was lower in class I (OR= 0.72 [0.52-0.98]) and class II (OR= 0.7 [0.53-0.93]) patients without being higher in underweight patients. Increasing age was a strong predictor of cardiovascular events (OR of mortality is 7.99 [5.83 - 10.83] for patients >84 years old). Multivariable adjustments did not affect the significance of the results. Conclusions: An obesity paradox is observed in patients with diabetes hospitalized for STEMI. Higher BMI is correlated with lower risk of mortality, cardiogenic shock, and atrial fibrillation. Underweight patients did not have a higher risk of cardiovascular events.