Author + information
- Received June 30, 2011
- Revision received September 5, 2011
- Accepted September 13, 2011
- Published online December 13, 2011.
- Sandeep R. Das, MD, MPH⁎,⁎ (, )
- Karen P. Alexander, MD†,
- Anita Y. Chen, MS†,
- Tiffany M. Powell-Wiley, MD, MPH⁎,
- Deborah B. Diercks, MD, MHSc‡,
- Eric D. Peterson, MD, MPH†,
- Matthew T. Roe, MD, MHSc† and
- James A. de Lemos, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Sandeep R. Das, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9047
Objectives The aim of this study was to assess the impact of extreme (class III) obesity (body mass index [BMI] ≥40 kg/m2) on care and outcomes in patients with ST-segment elevation myocardial infarction (STEMI).
Background Although its prevalence is increasing rapidly, little is known about the impact of extreme obesity on STEMI presentation, treatments, complication rates, and outcomes.
Methods The relationship between BMI and baseline characteristics, treatment patterns, and risk-adjusted in-hospital outcomes was quantified for 50,149 patients with STEMI from the National Cardiovascular Data Registry (NCDR) ACTION Registry–GWTG.
Results The proportions of patients with STEMI by BMI category were as follows: underweight (BMI <18.5 kg/m2) 1.6%, normal weight (18.5 kg/m2 ≤BMI <25 kg/m2) 23.5%, overweight (25 kg/m2 ≤BMI <30 kg/m2) 38.7%, class I obese (30 kg/m2 ≤BMI <35 kg/m2) 22.4%, class II obese (35 kg/m2 ≤BMI <40 kg/m2) 8.7%, and class III obese 5.1%. Extreme obesity was associated with younger age at STEMI presentation (median age 55 years for class III obese vs. 66 years for normal weight); a higher prevalence of diabetes, hypertension, and dyslipidemia; a lower prevalence of smoking; and less extensive coronary artery disease and higher left ventricular ejection fraction. Process-of-care measures were similar across BMI categories, including the extremely obese. Using class I obesity as the referent, risk-adjusted in-hospital mortality rates were significantly higher only for class III obese patients (adjusted odds ratio: 1.64; 95% confidence interval: 1.32 to 2.03).
Conclusions Patients with extreme obesity present with STEMI at younger ages and have less extensive coronary artery disease, better left ventricular systolic function, and similar processes and quality of care. Despite these advantages, extreme obesity remains independently associated with higher in-hospital mortality.
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR). ACTION Registry–GWTG is an initiative of the American College of Cardiology Foundation and the American Heart Association, with partnering support from the Society of Chest Pain Centers, the American College of Emergency Physicians, and the Society of Hospital Medicine. The registry is sponsored in part by the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. The views expressed in this report represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies, identified at http://www.ncdr.com. Dr. Diercks has received research support from Beckman Coulter and Nanosphere; and consulting fees from Daichii Sankyo. Dr. Peterson has received grant support BMS/Sanofi, Lilly, and Johnson & Johnson. Dr. Roe has received research funding from Eli Lilly, Hoffmann-La Roche, Bristol-Myers Squibb, Novartis, the American College of Cardiology, and the American Heart Association; and consulting fees or honoraria from KAI Pharmaceuticals, Bristol-Myers Squibb, Sanofi-Aventis, Merck, Orexigen Therapeutics, Helsinn Pharmaceuticals, AstraZeneca, and Regeneron. Dr. de Lemos has received speaker honoraria from BMS/Sanofi-Aventis; and consulting income from AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 30, 2011.
- Revision received September 5, 2011.
- Accepted September 13, 2011.
- American College of Cardiology Foundation