January 20, 2021Open Access
Prognostic significance of BMI after PCI treatment in ST-elevation myocardial infarction A cohort study from the Swedish Coronary Angiography and Angioplasty Registry
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Key result
The apparent protective effect of obesity on 1-year all-cause mortality after PCI for STEMI became non-significant after adjusting for covariates (HR 0.88), whereas overweight patients demonstrated the lowest adjusted mortality risk.
Why the study?
Although obesity promotes coronary artery disease, a high BMI appears to exert a protective effect after a coronary artery event, termed the obesity paradox.
Does BMI category predict 1-year all-cause mortality in patients undergoing PCI for STEMI?
Population
25,384 patients undergoing PCI for STEMI in Sweden
Comparison
Four categories of BMI vs normal weight (BMI 18.5-24.9 kg/m 2)
Design
Registry-based cohort study
Follow-up
1-year
Authors
Discussion
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Implication
Adjusted analyses nullify obesity's apparent protection post-STEMI PCI; leaves open whether BMI modifies mortality risk after full confounder control.
Study Design
Type
Cohort (n=25,384)
Multicenter
Yes
Structured PICO
Does BMI category predict 1-year all-cause mortality in patients undergoing PCI for STEMI?
P
Population
25,384 patients (mean age 67.7 years, 28.9% female) undergoing percutaneous coronary intervention for ST-elevation myocardial infarction in Sweden, followed for up to 1 year.
E
Exposure
BMI categories: Underweight (<18.5 kg/m2), Overweight (25.0-29.9 kg/m2), and Obese (≥30 kg/m2)
C
Comparator
Normal weight (BMI 18.5-24.9 kg/m2)
O
Outcome
1-year all-cause mortality and 30-day all-cause mortalityhard clinical
Main Result
Hazard Ratio: 0.88 (95% CI 0.75–1.02)
Absolute Event Rate: 6.9% vs 11.3%
After adjusting for covariates, overweight patients had the lowest 1-year mortality risk following PCI for STEMI, while the apparent protective effect of obesity (the 'obesity paradox') became non-significant.
Limitations
- Observational nature precludes causal inferences
- Potential for selection bias, residual confounding, and survival bias
- BMI does not distinguish between fat, muscle mass, and skeletal weight
- Lack of data on waist circumference or abdominal fatness
- Unintentional weight loss was not controlled
- Cause-specific mortality was not adjudicated
- Possibility of selection bias, residual confounding, and survival bias
- Cause-specific mortality was not studied
Cite This Study
Jamaly et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=25,384). Obesity (BMI ≥30 kg/m2) vs. Normal weight (BMI 18.5-24.9 kg/m2) was evaluated on 1-year all-cause mortality (HR 0.88, 95% CI 0.75-1.02). The apparent protective effect of obesity on 1-year all-cause mortality after PCI for STEMI became non-significant after adjusting for covariates (HR 0.88), whereas overweight patients demonstrated the lowest adjusted mortality risk.
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