Impact of metabolically healthy obesity on post percutaneous coronary intervention outcomes in patients with acute myocardial infarction: A nationwide propensity matched analysis

Obesity paradox in post-percutaneous coronary intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a known controversy. However, these studies included patients who had diabetes, hypertension, or hyperlipidemia. We studied relationship between metabolically healthy obesity (MHO—without diabetes, hypertension, or hyperlipidemia) and in-hospital post-PCI outcomes among AMI patients. We extracted data from National Inpatient Sample 2020 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for admissions of AMI patients who underwent PCI. We then identified patients with diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity index and Clinical Classifications Software and excluded them. Then, using Elixhauser comorbidity index, we identified patients with and without obesity, defined as BMI > 30 kg/m 2 and propensity score matching was done for age and sex. Later, multivariable regression analysis was done for in-hospital post-PCI outcomes. Among 25605 metabolically healthy patients who had AMI and underwent PCI, 2825 had obesity, and 22780 didn't. After propensity score matching (PSM) for age and sex, both cohorts had 2795 patients each. There was no statistically significant difference in in-hospital all-cause mortality (adjusted odds ratio [OR] 1.14, 95 % confidence interval [CI] 0.63–2.10, p = 0.661), post-PCI stroke (aOR 1.17, 95 % CI 0.50–2.75, p = 0.714), acute kidney injury (aOR 1.20, 95 % CI 0.84–1.72, p = 0.322), post-PCI bleeding (aOR 1.04, 95 % CI 0.35 to 3.12, p = 0.940) and intra or post-PCI cardiac arrest (aOR 1.14, 95 % CI 0.30 to 4.42, p = 0.835) between both cohorts. No statistically significant association was found between obesity and post-PCI outcomes in metabolically healthy patients with AMI. Larger studies are needed to explore the controversial “obesity paradox” in cardiovascular diseases. • Metabolic health of individuals needs to be considered when predicting post-PCI outcomes. • Using precise obesity markers like waist circumference, waist-to-hip ratio may clarify post-PCI outcomes in AMI patients with MHO. • Longitudinal studies are needed to assess how MHO transitions over time and impacts post-PCI outcomes.