Abstract
BackgroundObesity is now a recognized chronic comorbid condition which is highly prevalent in the United States. Obesity poses several health risks, affecting multiple organ systems. The cardiovascular system is particularly affected by obesity including its role in atherosclerotic disease and hence myocardial infarction (MI) from atheromatous plaque events. However, multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients.Materials and methodsData was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study included adult patients with a principal discharge diagnosis of AMI. This group was divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment myocardial infarction (NSTEMI). Obese patients were subdivided into two groups: mild-moderate obesity and morbid obesity. Primary outcome compared inpatient mortality. Secondary outcomes included rate of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), composite revascularization, mean length of hospitalization, total hospital charges, and rates of complications.ResultsIn patients with STEMI, mild to moderately obese patients had lower odds of mortality (aOR: 0.80, 95% CI: 0.715-0.906, p < 0.001) compared to non-obese patients. However, morbidly obese patients had higher odds of mortality (aOR: 1.26, 95% CI: 1.100-1.446, p < 0.001) compared to non-obese patients. Mild to moderately obese patients had higher odds of composite revascularization (aOR: 1.24, 95% CI: 1.158-1.334, p < 0.001), PCI (aOR: 1.08, 95% CI: 1.054-1.150, p = 0.014), and CABG (aOR: 1.46, 95% CI: 1.313-1.626, p < 0.001).ConclusionThe degree of obesity affects outcome of patients with AMI. Cardiovascular interventions during hospitalizations for AMI also varied with degree of obesity. This may have affected the outcome, especially among morbidly obese patients.
Highlights
Obesity is a recognized chronic comorbid condition which is highly prevalent in the United States
In patients with segment elevation myocardial infarction (STEMI), mild to moderately obese patients had lower odds of mortality compared to non-obese patients
Mild to moderately obese patients had higher odds of composite revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)
Summary
Obesity is a recognized chronic comorbid condition which is highly prevalent in the United States It has a higher prevalence among the middle age female population [1, 2]. Studies involving outcomes of AMI in obese population have yielded mixed results [7,8,9,10,11]. The cardiovascular system is affected by obesity including its role in atherosclerotic disease and myocardial infarction (MI) from atheromatous plaque events. Multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients
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