Key result
Obesity linked to ~49% fewer major events vs normal weight in younger STEMI patients.
Why the study?
The obesity paradox remains debated in STEMI patients undergoing primary PCI, with unclear relationships between BMI and long-term outcomes.
Does higher BMI improve long-term outcomes in STEMI patients undergoing primary PCI?
Cohort (n=1,429)
Does higher BMI improve long-term outcomes in STEMI patients undergoing primary PCI?
Odds Ratio: 0.508 (95% CI 0.344–0.75)
p-value: p=0.016
The obesity paradox (better outcomes with higher BMI) was observed only in younger (≤65 years) STEMI patients undergoing primary PCI, but not in older patients.
Obesity paradox limited to younger STEMI patients after PPCI; leaves open whether BMI influences outcomes or warrants age-specific risk stratification.
Aim. Obesity paradox remains a point of debate in ST‐segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods. Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m2; overweight, 24 kg/m2 ≤BMI < 28 kg/m2; obese, BMI ≥ 28 kg/m2). The primary outcome was death, acute myocardial infarction (AMI), or revascularization. Results. On long‐term follow‐up (mean follow‐up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413–0.979; p = 0.038), the odds radio for obesity in comparison with normal‐weight patients was 0.508 (95% CI: 0.344–0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome. Conclusion. The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.
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Wang et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,429). Obesity (BMI ≥ 28 kg/m2) vs. Normal weight (BMI < 24 kg/m2) was evaluated on Death, acute myocardial infarction (AMI), or revascularization (OR 0.508, 95% CI 0.344-0.750, p=0.016). In younger STEMI patients (≤65 years) undergoing primary PCI, obesity was associated with a lower risk of death, AMI, or revascularization compared to normal weight (OR 0.508; 95% CI 0.344-0.750).
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