Neck-to-Waist Ratio Identifies Chronic Hypertensive Phenotype and Occlusive Myocardial Infarction in Patients Presenting With Acute Coronary Syndrome

aim of this study was to evaluate the relationship between multiple conventional and novel anthropometric measurements and hypertension in patients presenting to the ED with ACS and whether anthropometric indices differ according to admission BP status and evaluated the relationship between regional adiposity-related anthropometric phenotypes and cardiovascular stress response in ACS presentations. Rather than representing a general population-based study, this study evaluates the association between ACS and elevated admission BP in a population already characterized by a substantial metabolic disease burden.

Study Overview

• Status: Completed
• Conditions: Hypertension; Obesity (Disorder); Acute Coronary Syndrome (ACS) Undergoing Percutaneous Coronary Intervention (PCI)

Detailed Description

Patients presenting to the ED with chest pain or anginal equivalents who were diagnosed with ACS after evaluation with physical examination, cardiac biomarkers, and imaging studies, and who were subsequently hospitalized for coronary imaging, were included in the study. Patients excluded from the study are presented in the study flowchart (Figure 1).

Vital parameters, including initial admission BP, pulse rate, oxygen saturation (SpO₂), and heart rate, as well as electrocardiographic findings, were recorded. Laboratory parameters obtained at initial admission, including complete blood count, biochemical parameters, blood gas analysis, and cardiac troponin levels, were recorded. Additional laboratory findings obtained after hospitalization, including uric acid, lipid profile, and proBNP levels, were also documented. Echocardiographic measurements performed prior to the procedure were recorded.

Anthropometric measurements were obtained immediately before the procedure or within the first 24 hours after the procedure. NC, WC, HC, and TC measurements were performed and waist-to-hip ratio (WHR), waist-to-thigh ratio (WTR), neck-to-waist ratio (NWR) were calculated accordingly. All anthropometric measurements were obtained in accordance with the standardized procedures outlined in the NHANES Anthropometry Procedures Manual [12]. Body weight was measured in kilograms using a digital weight scale, and height was measured in centimeters using a height scale. Anthropometric measurements were obtained in centimeters using a measurement tape and recorded accordingly.

Findings obtained after coronary angiography, including the affected vessel, number of involved vessels, degree of involvement, and procedures performed (PTCA, stent implantation, thrombus aspiration, CABG, no intervention), were documented.

Length of hospital stay (ward and intensive care unit), recurrent ED admissions, and 30-day mortality were also recorded. In this study, occlusive myocardial infarction (OMI) was defined as the presence of an acute culprit lesion causing complete or near-complete limitation of coronary blood flow (TIMI flow grade 0-2) requiring emergent reperfusion therapy, and patients were classified according to coronary angiographic findings.

Patients were divided into two groups according to BP measurements obtained at ED admission: elevated admission BP (systolic BP ≥135 mmHg and/or diastolicBP ≥85 mmHg) and normal admission BP groups ( systolic BP <135 or diastolic BP<85 and MAP >65 mmHg). Differences between these two groups were evaluated in terms of anthropometric measurements, laboratory and echocardiographic parameters, clinical outcomes, and the requirement for coronary intervention. Additionally, the same analyses were repeated after dividing the patients into two groups according to the presence or absence of previously known hypertension as comorbidity. Furthermore, patients with known hypertension were further subgrouped into elevated admission BP (systolic BP ≥135 mmHg and/or diastolic BP ≥85 mmHg) and normal admission BP groups, and the same analyses were performed again within these subgroups.

• Study Type: Observational
• Enrollment (Actual): 238

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Etlik City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients presenting to the ED with chest pain or anginal equivalents who were diagnosed with ACS after evaluation with physical examination, cardiac biomarkers, and imaging studies, and who were subsequently hospitalized for coronary imaging, were included in the study

Description

Inclusion Criteria:

• Patients presenting to the emergency department with chest pain or anginal equivalents, diagnosed with ACS, admitted to CICU for coronary angiography
• aged over 18 years

Exclusion Criteria:

• Patients with anatomical abnormalities in the regions where anthropometric measurements were to be performed (n=11)
• Patients with endocrinological disorders causing anatomical abnormalities of the neck, waist, or hip circumference (n=3)
• Patients with neck tumors (n=1)
• ACS patients who did not undergo coronary angiography(n=6)
• Etiologies causing secondary troponin elevation (e.g., pulmonary embolism, aortic dissection, hypoxia-related pathologies, sepsis, and anemia) (n=51)
• Mean arterial pressure < 65 mmHg (n=9)
• Patients unable to stand upright (n=18)
• Patients with ascites (n=1)

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
normal blood pressure at admission group; patients admitted to emergency department with normal blood pressure
elevated blood pressure at admission group; patients admitted to emergency department with elevated blood pressure

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association Between Anthropometric Phenotype and Elevated Admission Blood Pressure in Acute Coronary Syndrome	The primary outcome was the difference in conventional and regional adiposity-related anthropometric measurements between patients with elevated admission blood pressure and those with normal admission blood pressure at emergency department presentation.	Anthropometric measurements and blood pressure values were obtained during the index hospitalization, with anthropometric measurements performed immediately before coronary angiography or within the first 24 hours following the procedure.

Collaborators and Investigators

• Sponsor: Ercis Sehit Rıdvan Cevik State Hospital
• Collaborators: Ankara Etlik City Hospital
• Investigators: Principal Investigator: Elif Hamzaçebioğlu Kayışoğlu, MD, erciş şehit rıdvan çevik state hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 28, 2025
• Primary Completion (Actual): February 28, 2026
• Study Completion (Actual): February 28, 2026

Study Registration Dates

• First Submitted: June 24, 2026
• First Submitted That Met QC Criteria: June 24, 2026
• First Posted (Actual): June 30, 2026

Study Record Updates

• Last Update Posted (Actual): June 30, 2026
• Last Update Submitted That Met QC Criteria: June 24, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: obesity; hypertension; acute coronary syndrome; anthropometry; occlusive myocardial infarction
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Nutrition Disorders; Heart Diseases; Overnutrition; Body Weight; Overweight; Myocardial Ischemia; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Obesity; Hypertension; Acute Coronary Syndrome
• Other Study ID Numbers: antropometric

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No