OBESITY PARADOX AND ANGINA FREQUENCY IN PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION

Background and Objectives: Contemporary data on the prevalence, management and outcomes of acute myocardial infarction (AMI) in relation to body mass index (BMI) are limited. Materials and Methods: Using the National Inpatient Sample from 2008 through 2017, we identified adult AMI hospitalizations and categorized them into underweight (BMI < 19.9 kg/m2), normal BMI and overweight/obese (BMI > 24.9 kg/m2) groups. We evaluated in-hospital mortality, utilization of cardiac procedures and resource utilization among these groups. Results: Among 6,089,979 admissions for AMI, 38,070 (0.6%) were underweight, 5,094,721 (83.7%) had normal BMI, and 957,188 (15.7%) were overweight or obese. Over the study period, an increase in the prevalence of AMI was observed in underweight and overweight/obese admissions. Underweight AMI admissions were, on average, older, with higher comorbidity, whereas overweight/obese admissions were younger and had lower comorbidity. In comparison to the normal BMI and overweight/obese categories, significantly lower use of coronary angiography (62.3% vs. 74.6% vs. 37.9%) and PCI (40.8% vs. 47.7% vs. 19.6%) was observed in underweight admissions (all p < 0.001). The underweight category was associated with significantly higher in-hospital mortality (10.0% vs. 5.5%; OR 1.23 (95% CI 1.18–1.27), p < 0.001), whereas being overweight/obese was associated with significantly lower in-hospital mortality compared to normal BMI admissions (3.1% vs. 5.5%; OR 0.73 (95% CI 0.72–0.74), p < 0.001). Underweight AMI admissions had longer lengths of in-hospital stay with frequent discharges to skilled nursing facilities, while overweight/obese admissions had higher hospitalization costs. Conclusions: In-hospital management and outcomes of AMI vary by BMI. Underweight status was associated with worse outcomes, whereas the obesity paradox was apparent, with better outcomes for overweight/obese admissions.

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P2706Impact of age on obesity paradox in patients with acute myocardial infarction after primary percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehy565.p2706 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

S Fukuoka ◽

T Kurita ◽

K Dohi ◽

Y Sato ◽

T Ishise ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Obesity Paradox ◽

Percutaneous Coronary

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Abstract #300080: Challenging the Obesity Paradox Among Patients Admitted for Acute Myocardial Infarction

Endocrine Practice ◽

10.1016/s1530-891x(20)48247-3 ◽

2020 ◽

Vol 26 ◽

pp. 7

Author(s):

Hafeez Shaka

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Obesity Paradox

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Abstract 124: Recovery From Acute Myocardial Infarction in China: A Report From China PEACE Prospective Study of Acute Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.124 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Yuan Lu ◽

Jiamin Liu ◽

Yongfei Wang ◽

John Welsh ◽

Haibo Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Prospective Study ◽

Poor Quality ◽

Chinese Patients ◽

Important Improvement ◽

Angina Frequency ◽

Related Quality

Introduction: Despite a dramatic increase in the incidence of acute myocardial infarction (AMI) in China, little is known about patient’s health status in the year following discharge. We studied the change in angina frequency and angina-related quality of life at 1 year after AMI among Chinese patients. Methods: Among 3,336 patients admitted for AMI to 53 hospitals from December 2012 to May 2014 in the China PEACE Prospective Study of Acute Myocardial Infarction, Angina frequency and angina-related quality of life were assessed with the Seattle Angina Questionnaire (SAQ) at the time of hospitalization and 1 year later. Scores ranged from 0 to 100 points, with higher scores indicating fewer symptoms and better quality of life. We categorized both 1-year scores and changes in scores to support clinical interpretability. We considered a clinically poor outcome at 1 year to be an angina frequency score ≤ 60 (daily/weekly angina) or quality of life score ≤ 50 (poor/fair quality of life). A 1-year change in score ≥ 5 was improvement, a change between -5 and 5 was interpreted as no change, and ≤ -5 was interpreted as being significantly worse at 1 year than before the AMI. Results: Participants’ average age was 60.6 years (±11.9) and 22.8% were women. The response rate was about 75% and non-responders had similar characteristics compared with responders. At baseline, the mean scores were 86.3±21.9 for angina frequency and 66.7±24.0 for quality of life, with 16.3% having daily/weekly angina and 38.8% poor quality of life. One year later, 36.3% of patients had had a clinically important improvement in angina, 49.0% had no change, and 14.7% had worse symptoms. Similarly, 52.7% experienced a clinically important improvement in quality of life, 18.2% had no change, and 29.1% had worse quality of life. At 1 year after AMI, 5.5% of patients still had severe angina symptoms and 20.9% had poor quality of life. Conclusion: There is substantial variability in Chinese patients’ symptom and quality of life recovery after AMI and more work is needed to understand the causes of this variability and how best to improve symptoms and quality of life after AMI in China.

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Abstract P124: Perceived Stress in Acute Myocardial Infarction: Associations with Long-Term Health Status Outcomes

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap124 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Suzanne V Arnold ◽

Kim G Smolderen ◽

Donna M Buchanan ◽

Yan Li ◽

John A Spertus

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Health Status ◽

Chronic Stress ◽

Perceived Stress ◽

High Stress ◽

Angina Frequency ◽

Physical Limitations ◽

Independent Association ◽

Disease Specific

Background: Chronic stress is associated with adverse prognosis in cardiovascular disease, but little is known about its link with health status. We studied the association between chronic stress and health status following acute myocardial infarction (AMI). Methods: In the 24 center US TRIUMPH registry, 4204 AMI patients completed the Perceived Stress Scale-4 (scores range 0-16) during hospitalization. Moderate/high stress over the prior month was defined as scores in the top 2 quintiles (scores=6-16). Patients were assessed at 1 year for disease-specific health status with the Seattle Angina Questionnaire (SAQ) and for generic health status with a Visual Analog Scale (VAS) and the SF-12. Multivariable logistic regression evaluated the independent association between moderate/high stress and poor health status (defined as SAQ angina frequency <100; SAQ physical limitations <75; SAQ QOL <75; VAS <65; SF-12 physical <35; and SF-12 mental <45). Results: After extensive adjustment for demographic, socio-economic and clinical characteristics (including depressive symptoms), AMI patients with moderate/high stress had a greater likelihood of angina and poor disease-specific and generic health status (Figure; p<0.01 for all). Conclusion: Moderate/high stress at the time of an AMI is associated with poor post-AMI health status, even after adjustment for important confounders. Future studies need to examine whether stress mediates observed racial and socio-economic disparities, and whether novel interventions targeting chronic stress can improve post-AMI health status.

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