Key result
Obesity linked to ~12% lower odds of MACCE and reduced in-hospital mortality.
Why the study?
The association of obesity with invasive management and in-hospital outcomes in acute myocardial infarction complicated by cardiogenic shock among adults with diabetes mellitus was uncertain.
Is obesity associated with differences in invasive management and in-hospital outcomes in adults with diabetes mellitus and acute myocardial infarction complicated by cardiogenic shock?
Observational (n=19,399)
Yes
Is obesity associated with differences in invasive management and in-hospital outcomes in adults with diabetes mellitus and acute myocardial infarction complicated by cardiogenic shock?
Odds Ratio: 0.88 (95% CI 0.82–0.95)
In adults with diabetes and AMI complicated by cardiogenic shock, obesity is associated with a different invasive management pattern and lower in-hospital mortality, consistent with an obesity paradox.
Obesity may alter revascularization patterns in diabetic AMI shock; leaves open whether apparent paradox reflects selection bias or biology.
Background/Objectives: Obesity and diabetes mellitus coexist, but the association of obesity with invasive management and in-hospital outcomes in acute myocardial infarction (AMI) complicated by cardiogenic shock is uncertain. We evaluated these associations among adults with diabetes mellitus. Methods: We performed a retrospective discharge-level analysis of the National Inpatient Sample for 2016–2021. Obesity was identified from ICD-10-CM codes. Survey-design logistic regression accounted for weights, strata, hospital clusters, and prespecified covariates. Results: The cohort comprised 19,399 discharges, representing 96,995 hospitalizations; 24.1% had obesity. Angiography and coronary artery bypass grafting (CABG) were more frequent with obesity, whereas percutaneous coronary intervention (PCI) was less frequent. After adjustment, obesity was associated with higher odds of angiography (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.03–1.21) and CABG (aOR 1.49, 95% CI 1.35–1.63), lower odds of PCI (aOR 0.90, 95% CI 0.84–0.97), and similar odds of circulatory support (aOR 1.00, 95% CI 0.93–1.07). Adjusted odds were lower for major adverse cardiovascular and cerebrovascular events (aOR 0.88, 95% CI 0.82–0.95), in-hospital mortality (aOR 0.90, 95% CI 0.83–0.98), acute ischemic stroke (aOR 0.78, 95% CI 0.64–0.95), and major bleeding (aOR 0.86, 95% CI 0.76–0.98). Procedure adjustment attenuated mortality and major bleeding. Conclusions: Obesity was associated with a different invasive-management pattern and lower adjusted odds of several short-term outcomes, consistent with an apparent in-hospital obesity paradox in this high-risk population.
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Berezhnoi et al. (2026) conducted an observational in Diabetes mellitus and acute myocardial infarction complicated by cardiogenic shock (n=19,399). Obesity vs. Non-obese was evaluated on Major adverse cardiovascular and cerebrovascular events (aOR 0.88, 95% CI 0.82-0.95). Obesity was associated with lower odds of major adverse cardiovascular and cerebrovascular events (aOR 0.88; 95% CI 0.82-0.95) in adults with diabetes and AMI complicated by cardiogenic shock.
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