Document Detail

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).
MedLine Citation:
PMID:  22152950     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to assess the impact of extreme (class III) obesity (body mass index [BMI] ≥40 kg/m(2)) 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/m(2)) 1.6%, normal weight (18.5 kg/m(2) ≤BMI <25 kg/m(2)) 23.5%, overweight (25 kg/m(2) ≤BMI <30 kg/m(2)) 38.7%, class I obese (30 kg/m(2) ≤BMI <35 kg/m(2)) 22.4%, class II obese (35 kg/m(2) ≤BMI <40 kg/m(2)) 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.
Sandeep R Das; Karen P Alexander; Anita Y Chen; Tiffany M Powell-Wiley; Deborah B Diercks; Eric D Peterson; Matthew T Roe; James A de Lemos
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-05-11     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2642-50     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, 75390-9047, USA.
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MeSH Terms
Body Mass Index
Body Weight*
Hospital Mortality
Middle Aged
Myocardial Infarction / mortality*,  therapy
Obesity, Morbid / diagnosis,  mortality*,  therapy
Quality of Health Care
Grant Support
Comment In:
J Am Coll Cardiol. 2011 Dec 13;58(25):2651-3   [PMID:  22152951 ]
J Am Coll Cardiol. 2012 May 8;59(19):1731-2; author reply 1732   [PMID:  22554608 ]

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