Abstract
Aim Obesity paradox remains a point of debate in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m2; overweight, 24 kg/m2 ≤BMI < 28 kg/m2; obese, BMI ≥ 28 kg/m2). The primary outcome was death, acute myocardial infarction (AMI), or revascularization. Results On long-term follow-up (mean follow-up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413–0.979; p = 0.038), the odds radio for obesity in comparison with normal-weight patients was 0.508 (95% CI: 0.344–0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome. Conclusion The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.
Highlights
Obesity is highly prevalent among Chinese adults, and it has become a major public health challenge in China [1, 2]
Some controversial studies have demonstrated that overweight or obese patients with cardiovascular disease (CVD) may have a better prognosis than underweight or normal-weight CVD patients [5,6,7]. is phenomenon has been recognized as the “obesity paradox.” is “obesity paradox” has been reported in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). ese studies showed that obesity/overweight patients had a better prognosis, with a lower mortality and recurrent acute myocardial infarction (AMI) incidence than normal-weight patients
Age, smoking status, and chronic disease may be important confounders [8,9,10,11]. e obesity paradox may be due to the fact that patients with high body mass index (BMI) were younger than patients with low BMI
Summary
Obesity is highly prevalent among Chinese adults, and it has become a major public health challenge in China [1, 2]. Some controversial studies have demonstrated that overweight or obese patients with CVD may have a better prognosis than underweight or normal-weight CVD patients [5,6,7]. Is phenomenon has been recognized as the “obesity paradox.” is “obesity paradox” has been reported in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Ese studies showed that obesity/overweight patients had a better prognosis, with a lower mortality and recurrent acute myocardial infarction (AMI) incidence than normal-weight patients. E obesity paradox may be due to the fact that patients with high BMI were younger than patients with low BMI. Previous reports showed that smoking and chronic diseases are associated with high mortality and low BMI values, which may partly account for the obesity paradox. It has been suggested that obese patients tend to be treated more aggressively and have less bleeding
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