Author + information
- Received November 18, 2019
- Revision received January 27, 2020
- Accepted February 4, 2020
- Published online April 20, 2020.
- Bahira Shahim, MD, PhDa,∗,
- Björn Redfors, MD, PhDa,b,c,∗,
- Shmuel Chen, MD, PhDa,b,
- Holger Thiele, MDd,
- Ingo Eitel, MDe,
- Fotis Gkargkoulas, MDa,
- Aaron Crowley, MAa,
- Ori Ben-Yehuda, MDa,b,
- Akiko Maehara, MDa,b and
- Gregg W. Stone, MDa,f,∗ ()
- aClinical Trials Center, Cardiovascular Research Foundation, New York, New York
- bNewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- cSahlgrenska University Hospital, Gothenburg, Sweden
- dHeart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
- eUniversity Heart Center Lübeck and the German Center for Cardiovascular Research, Lübeck, Germany
- fThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Gregg W. Stone, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, New York 10019.
Objectives The aim of this study was to examine the association between body mass index (BMI), infarct size (IS) and clinical outcomes.
Background The association between obesity, IS, and prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction is incompletely understood.
Methods An individual patient-data pooled analysis was performed from 6 randomized trials of patients undergoing pPCI for ST-segment elevation myocardial infarction in which IS (percentage left ventricular mass) was assessed within 1 month (median 4 days) after randomization using either cardiac magnetic resonance (5 studies) or 99mTc sestamibi single-photon emission computed tomography (1 study). Patients were classified as normal weight (BMI <25 kg/m2), overweight (25 kg/m2 ≤BMI <30 kg/m2), or obese (BMI ≥30 kg/m2). The multivariable models were adjusted for age, sex, hypertension, hyperlipidemia, current smoking, left main or left anterior descending coronary artery infarct, baseline TIMI (Thrombolysis In Myocardial Infarction) flow grade 0 or 1, prior myocardial infarction, symptom–to–first device time, and study.
Results Among 2,238 patients undergoing pPCI, 644 (29%) were normal weight, 1,008 (45%) were overweight, and 586 (26%) were obese. BMI was not significantly associated with IS, microvascular obstruction, or left ventricular ejection fraction in adjusted or unadjusted analysis. BMI was also not associated with the 1-year composite risk for death or heart failure hospitalization (adjusted hazard ratio: 1.21 [95% confidence interval: 0.74 to 1.71] for overweight vs. normal [p = 0.59]; adjusted hazard ratio: 1.21 [95% confidence interval 0.74 to 1.97] for obese vs. normal [p = 0.45]) or for death or heart failure hospitalization separately. Results were consistent when BMI was modeled as a continuous variable.
Conclusions In this individual patient-data pooled analysis of 2,238 patients undergoing pPCI for ST-segment elevation myocardial infarction, BMI was not associated with IS, microvascular obstruction, left ventricular ejection fraction, or 1-year rates of death or heart failure hospitalization.
↵∗ Drs. Shahim and Redfors contributed equally to this work.
Dr. Maehara has received grant support from Abbott Vascular and Boston Scientific; and is a consultant for Conavi Medical. Dr. Stone is a consultant to Miracor, TherOx, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 18, 2019.
- Revision received January 27, 2020.
- Accepted February 4, 2020.
- 2020 American College of Cardiology Foundation
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