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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Impact of Body Weight and Extreme Obesity on the Presentation, Treatment, and In-Hospital Outcomes of 50,149 Patients With ST-Segment Elevation Myocardial Infarction

Results From the NCDR (National Cardiovascular Data Registry)

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^_*

^_* Division of Cardiology and Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, California

Manuscript received June 30, 2011; revised manuscript received September 5, 2011, accepted September 13, 2011.

^_* Reprint requests and correspondence: Dr. Sandeep R. Das, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9047 (Email: sandeep.das{at}utsouthwestern.edu).

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.

Key Words: extreme obesity • obesity • outcomes • quality of care • STEMI

Abbreviations and Acronyms   BMI = body mass index   GWTG = Get With the Guidelines   HF = heart failure   LV = left ventricular   MI = myocardial infarction   NCDR = National Cardiovascular Data Registry   NSTEMI = non–ST-segment elevation myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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