A-53 | In-Hospital Outcomes Following PCI For Acute Coronary Syndrome-Related Hospitalizations in Elderly Patients with Metabolically Healthy Vs. Metabolically Unhealthy Obesity: A Nationwide Propensity Score-Matched Analysis [2016-2020]

We studied in-hospital outcomes for obese geriatric patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI), comparing those with Metabolically Healthy Obesity (MHO) (absence of hypertension, diabetes, hyperlipidemia) and Metabolically Unhealthy Obesity (MUHO). Using the National Inpatient Sample (NIS) Database (2016-2020) and ICD-10 codes, we identified and classified obese elderly patients (≥65 years) with ACS undergoing PCI into two groups: MUHO and MHO. We compared the comorbidities and in-hospital outcomes in both groups after propensity matching for age, sex, and race. Our study cohort, after 1:1 propensity score matching from 143,335 weighted admissions, included 5,990 patients evenly divided into two groups of 2,995 each, predominantly male and white, with a median age of 70 years. The MUHO group had higher rates of depression (12.7% vs. 6.5%), chronic pulmonary disease (24.9% vs. 19.5%), prior myocardial infarction (15.9% vs. 6.2%), and prior stroke (7.5% vs. 2.8%) (all p<0.001) as compared to the MHO group. However, the MHO group had significantly higher rates of all-cause mortality (12.4% vs. 2.8%), cardiogenic shock (18.5% vs. 7%), post procedural stroke (2.2% vs 1%), need for Impella (5.2% vs. 2.7%), and intra-aortic balloon pump use (8.8% vs. 3.8%) (all p<0.001) in comparison to the MUHO group. (Table 1) Our study revealed that MHO geriatric patients with ACS undergoing PCI had paradoxically worse in-hospital outcomes despite having lower rates of comorbidities compared to the MUHO cohort. Future prospective studies must be done to validate this paradox.