Abstract 13188: Impact of Obesity on Presentation, Treatment, and In-Hospital Mortality for 49,329 Patients With ST-Segment Elevation Myocardial Infarction in the ACTION-GWTG Registry
Background: The relationship between obesity and the in-hospital course of patients with STEMI has not been well characterized.
Methods: Using data from the ACTION-GWTG registry, we examined the relationship between body mass index (BMI) and baseline characteristics, treatment patterns, and in-hospital outcomes for 49,329 patients from 343 centers with STEMI and BMI≥18.5 kg/m2. BMI was categorized according to NHLBI criteria: normal weight (18.5≤BMI<25 kg/m2), overweight (25≤BMI<30), obese I (30≤BMI<35), obese II (35≤BMI<40), and obese III (BMI≥40). Patients with BMI<18.5 (n=820) were excluded. Odds of death by BMI category was calculated, adjusted for creatinine, age, SBP, troponin, HF, ECG, heart rate, and PAD.
Results: The proportion of STEMI patients by BMI category was: normal weight 24%, overweight 39%, class I, II, and III obese 23%, 9%, and 5% (Table). Increasing obesity was associated with younger age, higher prevalence of diabetes, hypertension, or dyslipidemia, and lower prevalence of smoking. Overweight and obese patients were less likely to present in heart failure and had less extensive coronary artery disease. Estimated GFR increased modestly with increasing obesity. Most process of care measures, including rates of reperfusion, were similar across BMI categories. Compared to normal weight patients (Figure), the adjusted odds of death was similar for up to moderately obese patients, and higher for class III obese patients (OR=1.49, 95% CI 1.19–1.87).
Conclusion: In patients with STEMI, BMI>40 kg/m2 was associated with increased odds of in-hospital death. Differences in process of care across BMI categories did not appear clinically meaningful.
- © 2010 by American Heart Association, Inc.