Prognostic significance of BMI after PCI treatment in ST-elevation myocardial infarction: a cohort study from the Swedish Coronary Angiography and Angioplasty Registry

Shabbar Jamaly, Bjorn Redfors, Elmir Omerovic, Lena Carlsson, Kristjan Karason, Shabbar Jamaly, Bjorn Redfors, Elmir Omerovic, Lena Carlsson, Kristjan Karason

Abstract

Background: Obesity along with clustering of cardiovascular risk factors is a promoter for coronary artery disease. On the other hand, a high body mass index (BMI) appears to exert a protective effect with respect to outcomes after a coronary artery event, termed the obesity paradox.

Methods: The Swedish Coronary Angiography and Angioplasty Registry collects information on all patients who undergo percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in Sweden along with demographic and procedure-related data. We studied the predictability of four categories of BMI for 1-year all-cause mortality in people with STEMI undergoing PCI.

Results: Among 25 384 patients, mean (SD) age 67.7 (12.1) years and 70.2% male, who underwent PCI for STEMI, a total of 5529 (21.8%) died within 1 year. Using normal weight (BMI 18.5-24.9 kg/m2) as a reference, subjects with obesity (BMI ≥30 kg/m2) had a low 1-year all-cause mortality risk in unadjusted analysis, HR 0.59 (95% CI 0.53 to 0.67). However, after adjustment for age, sex and other covariates, the difference became non-significant, HR 0.88 (95% CI 0.75 to 1.02). Patients with overweight (BMI 25.0-29.9 kg/m2) had the lowest 1-year mortality risk in analysis adjusted for age, sex and other covariates, HR 0.87 (95% CI 0.79 to 0.97), whereas those with underweight (BMI <18.5 kg/m2) had the highest mortality in both unadjusted HR 2.22 (95% CI 1.69 to 2.92) and adjusted analysis, HR 1.62 (95% CI 1.18 to 2.23).

Conclusion: The protective effect of obesity with respect to 1-year mortality after coronary intervention became non-significant after adjusting for age, sex and relevant covariates. Instead, overweight people displayed the lowest risk and underweight individuals the highest risk for adjusted all-cause mortality.

Trial registration number: NCT02311231.

Keywords: coronary artery disease; obesity; percutaneous coronary intervention.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Thirty-day all-cause mortality after percutaneous coronary intervention in STEMI for different body mass index categories.
Figure 2
Figure 2
One-year all-cause mortality after percutaneous coronary intervention in STEMI for different body mass index categories.
Figure 3
Figure 3
Unadjusted and adjusted risk for mortality (95% CI) in patients with STEMI using log-10 scale for the x-axis.
Figure 4
Figure 4
Unadjusted and adjusted fractional polynomial Cox proportional-hazards regression (95% CI, shaded area) with continuous risk relationship between body mass index and all-cause mortality after percutaneous coronary intervention treatment for STEMI.

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