Date Published: June 14, 2019
Publisher: Public Library of Science
Author(s): Dae-Won Kim, Sung-Ho Her, Ha Wook Park, Mahn-Won Park, Kiyuk Chang, Wook Sung Chung, Ki Bae Seung, Tae Hoon Ahn, Myung Ho Jeong, Seung-Woon Rha, Hyo-Soo Kim, Hyeon Cheol Gwon, In Whan Seong, Kyung Kuk Hwang, Shung Chull Chae, Kwon-Bae Kim, Young Jo Kim, Kwang Soo Cha, Seok Kyu Oh, Jei Keon Chae, Chiara Lazzeri.
Beneficial effects of overweight and obesity on mortality after acute myocardial infarction (AMI) have been described as “Body Mass Index (BMI) paradox”. However, the effects of BMI is still on debate. We analyzed the association between BMI and 1-year clinical outcomes after AMI.
Among 13,104 AMI patients registered in Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015, 10,568 patients who eligible for this study were classified into 3 groups according to BMI (Group 1; < 22 kg/m2, 22 ≤ Group 2 < 26 kg/m2, Group 3; ≥ 26 kg/m2). The primary end point was all cause death at 1 year. Over the median follow-up of 12 months, the event of primary end point occurred more frequently in the Group 1 patients than in the Group 3 patients (primary endpoint: adjusted hazard ratio [aHR], 1.537; 95% confidence interval [CI] 1.177 to 2.007, p = 0.002). Especially, cardiac death played a major role in this effect (aHR, 1.548; 95% confidence interval [CI] 1.128 to 2.124, p = 0.007). Higher BMI appeared to be good prognostic factor on 1-year all cause death after AMI. This result suggests that higher BMI or obesity might confer a protective advantage over the life-quality after AMI.
The prevalence and socio-economic influence of obesity are dramatically increasing over the globe. In general, obesity is well known to be related to aggravated cardiovascular disease [1–6]. However, several studies showed restrictive impacts on cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) [7–9]. Clinical effects of body mass index (BMI) after PCI in acute myocardial infarction (AMI) are still controversial. Some previous reports revealed that obesity paradox was observed but not reached to the significant difference after the multivariate analysis [10, 11], whereas other studies showed that obese patients with AMI had an improved prognosis after primary PCI [9, 12, 13]. Therefore, the aim of the present study ought to evaluate the clinical outcome in patients with AMI undergoing PCI in accordance with weight status.
The present study unearthed that the group with low BMI had poor clinical profiles including older age, a higher proportion of female, CKD, prior CHF, cerebrovascular disease and atrial fibrillation/flutter, lower Hb, higher inflammation marker as well as aggravated heart failure. On the other hand, although the group with high BMI had patients with younger age, a higher proportion of male and greater use of medications, it had relatively worse lipid profiles and risk factors including family history of CAD, hypertension, hyperlipidemia and current/recent smoker. Nevertheless, our clinical results demonstrated that the high BMI group is associated with better clinical outcomes in long-term follow-up in patients with AMI undergoing PCI.
The current analysis of the KAMIR-NIH registry showed the clinical implications of BMI in patients with AMI undergoing PCI. Patients with higher levels of baseline BMI had better risk-profiles of baseline clinical, laboratory, and angiographic characteristics and also had favorable clinical outcomes. Further studies are required to address the optimal cut-off value in Asian population and long-term effects for patients with AMI and various BMI. Also, further clinical trials to evaluate beneficial effects of central obesity would be helpful to give an explanation of obesity paradox.