Preexisting obesity in patients with first-time MI was associated with decreased odds of in-hospital mortality for both STEMI (OR 0.7493, p=0.00) and NSTEMI (OR 0.6927, p=0.00).
Cohort (n=3,539,274)
Yes
Does preexisting obesity reduce in-hospital mortality in patients admitted for first-time myocardial infarction?
Patients with first-time MI and preexisting obesity have lower in-hospital mortality but higher rates of coronary angiography and CABG, reinforcing the obesity paradox.
Effect estimate: OR 0.7493 (STEMI) and OR 0.6927 (NSTEMI)
p-value: p=0.00
Abstract Rationale Myocardial infarction (MI) is defined as the acute reduction in coronary blood flow resulting in ischemia and myocardial cell death. Obesity is a chronic, multifactorial disease characterized by excessive adipose tissue accumulation that impedes health and raises the risk of comorbidities and premature mortality. Although obesity is considered a well-established, independent risk factor for MI, the effect of preexisting obesity on individuals hospitalized with first-time MI remains relatively under examined. Our study aimed to assess the link between preexisting Obesity and inpatient outcomes among MI hospitalizations using a large national database in the United States. Methods A retrospective cohort analysis using the National Inpatient Sample (NIS) Database from 2016-2022 was conducted. Patients admitted with a primary diagnosis of a first time MI (ST Elevated Myocardial Infarction (STEMI) and Non-ST Elevated Myocardial Infarction (NSTEMI) ), with preexisting Obesity were identified using ICD-10 codes. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total charges, and use of various interventions. Univariate analysis was done and variables with p 0. 2 were considered for multivariate analysis, adjusting by age, gender, race, Charlson comorbidity index, hospital location and teaching status, size, region and insurance status. Significance was defined as p 0. 05 Results Among 1, 022, 535 STEMI hospitalizations, 191, 820 (18. 76%) had preexisting Obesity. These patients had decreased odds of mortality (OR: 0. 7493, p = 0. 00), LOS (0. 12, p = 0. 00) and intubation (OR: 0. 8648, p = 0. 00). However, they had increased odds of undergoing a Coronary Angiogram (OR: 1. 1670, p = 0. 00) and Coronary Artery Bypass Grafting (CABG) (OR: 1. 4533, p = 0. 00). Among 2, 516, 739 NSTEMI hospitalizations, 553, 939 (22. 01%) had preexisting Obesity. These patients had decreased odds of mortality (OR: 0. 6927, p = 0. 00), but with an increase in both LOS (0. 2815, p = 0. 00) and charges (10, 138. 68, p = 0. 00). They had decreased odds of intubation (OR: 0. 8940, p = 0. 00) but increased odds of undergoing Coronary Angiogram (OR: 1. 2480, p = 0. 00) and CABG (OR: 1. 5529, p = 0. 00). Conclusion Patients with first-time MI and preexisting obesity encountered statistically significant decreased odds of inpatient mortality and intubation, while experiencing increased odds of undergoing coronary angiography and CABG. Our results reinforce the “obesity paradox, ” where obese patients with myocardial infarction experience lower in-hospital mortality despite higher comorbidity burden and more frequent invasive procedures. They are also more likely to receive critical interventions such as coronary angiography and CABG, which may contribute to lower mortality. The increased rates of angiography and CABG may reflect provider bias, differences in clinical presentation, or more aggressive management strategies in obese patients. This abstract is funded by: None
Yapp et al. (Fri,) conducted a cohort in First-time Myocardial Infarction (STEMI and NSTEMI) (n=3,539,274). Preexisting obesity vs. No preexisting obesity was evaluated on In-hospital mortality (OR 0.7493 (STEMI) and OR 0.6927 (NSTEMI), p=0.00). Preexisting obesity in patients with first-time MI was associated with decreased odds of in-hospital mortality for both STEMI (OR 0.7493, p=0.00) and NSTEMI (OR 0.6927, p=0.00).