Abstract 15541: In-Hospital Mortality in Obese Patients With Cardiogenic Shock Complicating Non-ST- and ST-Elevation Myocardial Infarction
Background: Previous studies have described ‘obesity paradox’ (lower short- and long-term mortality in obese as compared to non-obese patients) in acute coronary syndromes. However, data available on outcomes in obese patients with cardiogenic shock complicating acute myocardial infarction are limited.
Objectives: To determine the association between obesity and in-hospital mortality in patients with cardiogenic shock complicating non-ST- and ST-elevation myocardial infarction (NSTEMI and STEMI).
Methods: Retrospective analysis of the 2006-2010 Nationwide Inpatient Sample databases. Patients aged ≥40 years with a diagnosis of NSTEMI or STEMI and cardiogenic shock were identified using ICD-9-CM codes. Obese patients were identified using the chronic condition code (CM_OBESE) based on ICD-9-CM codes. Logistic regression was used to compare in-hospital mortality between obese and non-obese patients. Patients were also stratified according to age to examine the effect of age on differences in in-hospital mortality.
Results: Of 147,620 patients with acute myocardial infarction and cardiogenic shock, 48,813 (33.1%) had NSTEMI and 98,807 (67.9%) had STEMI. In patients with NSTEMI and cardiogenic shock (8.3% obese), overall risk-adjusted in-hospital mortality was lower in obese as compared to non-obese patients (OR 0.85, 95% CI 0.78-0.92). When stratified according to age, lower in-hospital mortality among obese patients was observed only in the 65-79 age group (OR 0.73, 95% CI 0.64-0.83), but not in 40-64 and ≥80 age groups. In patients with STEMI and cardiogenic shock (7.9% obese), there was no difference in overall risk-adjusted in-hospital mortality between obese and non-obese patients (OR 1.00, 95% CI 0.94-1.07). Age stratified subgroup analysis also revealed no difference in in-hospital mortality among obese and non-obese patients with STEMI and cardiogenic shock in any of the three age groups.
Conclusion: In patients with NSTEMI and cardiogenic shock, obese patients aged 65-79 years have lower in-hospital mortality than their non-obese counterparts, consistent with the phenomenon of ‘obesity paradox’. There is no mortality difference between obese and non-obese patients with STEMI complicated by cardiogenic shock.
- © 2013 by American Heart Association, Inc.