The impact of body mass index on the presentation, treatment and clinical outcomes of patients with ST-segment elevated myocardial infarction / 中华流行病学杂志

ABSTRACT

Objective To analyze the impact of body mass index (BMI) on the presentation,treatment,and clinical outcomes of patients with ST-segment elevated myocardial infarction (STEMI).Methods 1414 patients with STEMI who were admitted to the 20 hospitals in Liaoning region from May 2009 until May 2010 were enrolled.Patients were stratified according to the BMI levels as normal weight group (18.5 kg/m2≤BMI＜24.0 kg/m2) (n＝485),overweight (24.0 kg/m2≤BMI＜28.0 kg/m2) (n＝736),or obesity (BMI≥28.0 kg/m2) (n＝193).Presentation,treatment and mortality during hospitalization,MACCE (cardiovascular death,non-fatal myocardial infarction,revascularization and stroke) were compared between the three groups at 3-month and 1-year follow-up.Results Obesity in patients with STEMI was associated with younger age (P＜0.001),being male (P＜0.001),with diabetes (P＝0.013) or hypertension (P＜0.001) and hyperlipidmia (P＜0.001).A higher prevalence of reperfusion treatment (P ＝ 0.018),mainly percutaneous coronary intervention (PCI) (P＜0.001) was seen during the period of hospitalization.Rates of using other kinds of medicines as well as the mortalities during hospitalization,were similar among the groups with different BMI categories.At 3-month and 1-year follow-up,more use of asprin (3-monthsP＝0.018; 1-yearP＝0.002) and β-receptor blockers were seen in the obesity group (3-monthsP＝0.025; 1-yearP＝0.030) while the use of other drugs were not significantly different among the three groups.The incidence rates of MACCE were not significantly different among the BMI categories while the cumulative survival rate was similar between obese group and normal weight group.Results from the Cox proportional hazards analysis indicated that factors as age (HR＝1.045,95％ CI1.028-1.062,P＜0.001),diabetes (HR＝ 1.530,95％ CI1.107-2.301,P＝0.041),hyperlipidmia (HR＝2.127,95％ CI1.317-3.435,P＝0.002),urgent PCI (HR＝0.473,95％CI0.307-0.728,P＝0.001) and the use of β-receptor blockers at 3-months follow-up period (HR＝0.373,95％ CI0.195-0.713,P＝0.003) were significantly related to the incidence of MACCE at 1-year follow-up period.Conclusion Despite the fact that patients with obesity presented with STEMI at younger age and having received active treatment of reperfusion and medicine,both the 3-month and 1-year outcomes did not show significant difference among the BMI categories.