Severe obesity in patients with ST-elevation myocardial infarctions: association with age, temporal trends, and clinical outcomes

Aims This study aimed to determine the prevalence of severe obesity [body mass index (BMI) ≥ 40 kg/m²] among patients with ST-elevation myocardial infarction (STEMI) and clarify its association with age, temporal trends, and outcomes. Methods and results Consecutive patients admitted to a German heart centre between 2006 and 2022 for STEMI were categorized into five BMI groups according to the World Health Organization classification. Among the 11 629 STEMI patients, 269 (2.3%) had severe obesity. These patients were more likely to be female, have diabetes, and were on average 8.6 years younger than normal-weight patients (57.8 ± 12 vs. 66.4 ± 14 years, P < 0.01). The prevalence of severe obesity increased from 1.9 to 2.6% (2006–13 vs. 2013–22, P = 0.014), with the increase being a greater in females than in males (2.5–3.7%, P = 0.052). In younger patients (<55 years), prevalence rates increased by 128% in females (4.9–11.3%, P < 0.01) and 71% in men (2.2–3.7%, P < 0.01). Severe obesity did not affect treatment outcomes or in-hospital adverse event rates but was associated with higher 30-day [14.2% vs. 9.2%; adjusted hazard ratio (HR), 1.99; 95% confidence interval (CI), 1.4–3.0; P < 0.01] and 5-year mortality rates (30.6% vs. 20.6%; adjusted HR, 2.03; 95% CI, 1.4–2.9; P < 0.01). Conclusion The significant increase in the prevalence of severe obesity among patients with STEMI, particularly among females and younger individuals, underscores the urgent need for more effective prevention and treatment strategies to improve their long-term prognosis.