Impact of BMI on Outcomes After Primary Angioplasty in AMI
Background: The prognostic importance of obesity after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is unknown. We therefore sought to investigate the impact of body mass index (BMI) in patients with AMI undergoing primary PCI.
Methods: In the CADILLAC trial, 2082 patients of any age with AMI within 12 hours onset undergoing primary PCI were randomized to balloon angioplasty versus stenting, each ±abciximab. Outcomes were stratified by baseline BMI.
Results: Baseline BMI was measured in 2035 (98%) randomized patients; 552 (27%) patients have normal weight (BMI <25 kg/m), 915 (45%) were overweight (≥25 to <30 kg/m), and 568 (28%) were obese (≥30 kg/m). Compared with normal-weight patients, obese patients were younger and more frequently had diabetes, hyperlipidemia, hypertension, non–anterior myocardial infarction, and higher creatinine clearance. Obese patients were less likely to develop thrombocytopenia (1.8% vs 4.2%), moderate hemorrhagic complications (1.4% vs 3.3%), or required blood product transfusions (3.2% vs 6.3%) (all P ≤ .04). Obese compared with normal-weight patients had lower inhospital mortality (0.9% vs 2.7%, P = .03) at 30 days (1.1% vs 3.8%, P = .02) and 1 year (1.8% vs 7.5%, P < .0001). Independent predictors of 30-day and 1-year mortality included lower ejection fraction, advanced age, 3-vessel disease, anterior AMI, and lower creatinine clearance, but not BMI.
Conclusions: Obese patients with AMI have an improved prognosis after primary PCI compared with normal-weight patients, a finding attributable to AMI onset at younger age, with better renal function and less anterior infarction.
Epidemiologic studies provide evidence that obesity is associated with increased rates of myocardial infarction (MI) and death from cardiovascular diseases. However, several large clinical trials demonstrated that obese patients have a better prognosis than patients with normal weight after either percutaneous or surgical revascularization.
Data on the impact of body mass index (BMI) on the outcome of patients with acute myocardial infarction (AMI) are limited. In a cohort of 1760 patients with AMI studied before the advent of reperfusion therapy, 1-year mortality was not related to body weight. Among 41021 patients enrolled in the GUSTO-I randomized trial of 4 thrombolytic strategies, 30-day mortality was weakly associated with both weight and height, with lighter and shorter patients exhibiting a higher risk. Higher BMI was also predictive of improvement in left ventricular function between 90 minutes and 5 to 7 days.
No data are available on the impact of obesity on the outcomes of patients with AMI undergoing primary percutaneous coronary intervention (PCI). We therefore examined the database from the large, multicenter randomized CADILLAC trial to determine the effect of BMI on early and late prognosis of patients with AMI treated with primary PCI.
Abstract and Introduction
Abstract
Background: The prognostic importance of obesity after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is unknown. We therefore sought to investigate the impact of body mass index (BMI) in patients with AMI undergoing primary PCI.
Methods: In the CADILLAC trial, 2082 patients of any age with AMI within 12 hours onset undergoing primary PCI were randomized to balloon angioplasty versus stenting, each ±abciximab. Outcomes were stratified by baseline BMI.
Results: Baseline BMI was measured in 2035 (98%) randomized patients; 552 (27%) patients have normal weight (BMI <25 kg/m), 915 (45%) were overweight (≥25 to <30 kg/m), and 568 (28%) were obese (≥30 kg/m). Compared with normal-weight patients, obese patients were younger and more frequently had diabetes, hyperlipidemia, hypertension, non–anterior myocardial infarction, and higher creatinine clearance. Obese patients were less likely to develop thrombocytopenia (1.8% vs 4.2%), moderate hemorrhagic complications (1.4% vs 3.3%), or required blood product transfusions (3.2% vs 6.3%) (all P ≤ .04). Obese compared with normal-weight patients had lower inhospital mortality (0.9% vs 2.7%, P = .03) at 30 days (1.1% vs 3.8%, P = .02) and 1 year (1.8% vs 7.5%, P < .0001). Independent predictors of 30-day and 1-year mortality included lower ejection fraction, advanced age, 3-vessel disease, anterior AMI, and lower creatinine clearance, but not BMI.
Conclusions: Obese patients with AMI have an improved prognosis after primary PCI compared with normal-weight patients, a finding attributable to AMI onset at younger age, with better renal function and less anterior infarction.
Introduction
Epidemiologic studies provide evidence that obesity is associated with increased rates of myocardial infarction (MI) and death from cardiovascular diseases. However, several large clinical trials demonstrated that obese patients have a better prognosis than patients with normal weight after either percutaneous or surgical revascularization.
Data on the impact of body mass index (BMI) on the outcome of patients with acute myocardial infarction (AMI) are limited. In a cohort of 1760 patients with AMI studied before the advent of reperfusion therapy, 1-year mortality was not related to body weight. Among 41021 patients enrolled in the GUSTO-I randomized trial of 4 thrombolytic strategies, 30-day mortality was weakly associated with both weight and height, with lighter and shorter patients exhibiting a higher risk. Higher BMI was also predictive of improvement in left ventricular function between 90 minutes and 5 to 7 days.
No data are available on the impact of obesity on the outcomes of patients with AMI undergoing primary percutaneous coronary intervention (PCI). We therefore examined the database from the large, multicenter randomized CADILLAC trial to determine the effect of BMI on early and late prognosis of patients with AMI treated with primary PCI.