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Impact of BMI on Long-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction after Primary

Jinwen Wang1, Changhua Wang2, Zhechun Zeng1

  • 1Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.

International Journal of Clinical Practice
|June 10, 2022
PubMed

Insights

The obesity paradox in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) was observed only in younger individuals. Overweight and obese younger patients had better outcomes than normal-weight patients.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Public Health

Background:

  • The obesity paradox, where higher body mass index (BMI) is associated with better outcomes in certain conditions, is debated in ST-segment elevation myocardial infarction (STEMI).
  • Understanding the relationship between BMI and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) is crucial for risk stratification and treatment strategies.

Purpose of the Study:

  • To investigate the association between body mass index (BMI) and clinical outcomes in STEMI patients treated with PPCI.
  • To determine if the obesity paradox exists in different age groups within the STEMI population undergoing PPCI.

Main Methods:

  • A cohort of 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing was analyzed.
  • Patients were categorized by age (≤65 years and >65 years) and BMI (normal: <24 kg/m², overweight: 24-28 kg/m², obese: ≥28 kg/m²).
  • The primary outcome was a composite of death, acute myocardial infarction (AMI), or revascularization, assessed during long-term follow-up (mean 59 months).

Main Results:

  • The overall incidence of the primary adverse event was 13.9% during follow-up.
  • In younger STEMI patients (≤65 years), overweight (OR 0.741, p=0.038) and obese (OR 0.508, p=0.016) individuals had significantly better outcomes compared to normal-weight patients.
  • In elderly STEMI patients (>65 years), factors associated with the primary outcome included diabetes, hypertension, triple-vessel disease, regular exercise, ACEI/ARB use, and bleeding complications. Low BMI was not a significant predictor in this group.

Conclusions:

  • The obesity paradox was identified exclusively in the younger age group of STEMI patients treated with PPCI.
  • These findings suggest that BMI-related outcomes in STEMI may be age-dependent, highlighting the need for tailored clinical approaches.
Abstract

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