Impact of obesity on in-hospital mortality and 1-year clinical outcome in patients withST-segment elevation myocardial infarction undergone primary percutaneous coronary intervention : Data from INTERSTELLAR cohort

초록

Background: Recent studies have suggested an obesity paradox, whereby obesity may be associated with more favorable outcomes in patients with coronary artery disease.So, we investigate the impact of obesity on in-hospital mortality and 1-year clinical outcome in patient with ST-segment elevation myocardial infarction (STEMI)underwentprimary percutaneous coronary intervention (PCI). Methods:A total of 1540 patients with STEMI underwent primary PCI between July 2007 and June 2014 were analyzed retrospectively. Patientswere divided into three groups according to body mass index (BMI). Primary endpoint was in-hospital mortality and 1-year major adverse cardiac and cerebrovascular events (MACCEs), defined as the composite of all-cause death, non-fatal MI, stroke or admission for heart failure. Results: Each group was well balanced with respect to demographic characteristics. There were also no significant differences of Killip class, incidence of anterior wall MI, and peak level of CK-MB among three groups. However, Left ventricular systolic dysfunction (ejection fraction < 40%) was more common in the normal group compared to the overweight or obese group (23.5% vs. 19.8% vs. 15.5%, p=0.049, respectively).The incidence of in-hospital death was significantly higher in the normal weight group than those in the overweight or obese group (7.9% vs. 4.3% vs. 5.5%, p=0.020, respectively). The cumulative incidence of 1-year MACCEs was also higher in the normal weight group, compared with the overweight or obese group (18.2% vs. 13.5% vs. 10.4%, p=0.027, respectively). However, normal weight was not independent predictor for in-hospital mortality or 1-year clinical outcomes in the multivariate analysis adjusting for age, sex, diabetes, anterior MI and left ventricular systolic dysfunction. Conclusions: Although patients with normal weight was associated with worse clinical outcomes compared with overweight or obese patients.