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Obesity is major risk factor for cardiovascular disease. However, the prognostic implications of obesity in patients with acute coronary syndrome (ACS) remains ill defined. Some published data suggest a better outcome in obese patients with ACS while others have failed to find such an association. Such a relation remains unclear. We examined the impact of obesity on in-hospital mortality in patients presenting with AMI.
The Nationwide Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project, is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from United States community hospitals. Using the NIS, we identified 374061 adult patients presenting with AMI, both ST elevation myocardial infarction and non-ST elevation myocardial infarction (NSTEMI). Among those, 40707 had a diagnosis of obesity.
Patients with obesity were in general younger (60.5 yrs. vs. 68.4 yrs. p<0.001), with a lower proportion of males (58% vs. 61%, p<0.001), and a higher frequency of hypertension (61% vs. 51%, p<0.001), and diabetes mellitus (53% vs. 31%, p<0.001), but a lower frequency of chronic kidney disease (16.1% vs. 17.1%, p<0.001) including patients on dialysis (2.4% vs. 3.3%, p< 0.001), compared to patients without obesity. Obese patients were more likely to have a NSTEMI when presenting with an AMI (69% vs. 66%, p< 0.001) and less LBBB AMI (3.9°% vs. 5.5°%, p< 0.001) compared to non-obese patients. They were also less likely to have shock (4.0% vs. 5.4%, p<0.001) and more likely to be treated with PCI (49% vs. 43%, p<0.001) and CABG (13% vs. 8 %, p<0.001) and had a shorter hospital stay (4.7 vs. 4.9 days, p<0.001). The in-hospital mortality rate for patients with AMI and obesity was 2.8%, compared to 6.0% in patients without obesity (p<0.001). After adjusting for pertinent clinical and procedural variables using logistic regression analysis, obesity remained an independent predictor of lower in-hospital mortality (p<0.001, OR 0.84[0.78-0.90]).
In patients presenting with acute myocardial infarction, obesity is associated with lower in-hospital mortality.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Body Size and MI Risk: Is Bigger Better?
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1128M-198
- 2013 American College of Cardiology Foundation