Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis

Abstract Background The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients. Methods A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model. Results In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p<0.001) with significantly lower 30-day readmission rates as well (p<0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p<0.001). Conclusion In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age. Funding Acknowledgement Type of funding source: None

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Abstract #778009: The Obesity Paradox, Outcomes For Obese Patients Presenting With Acute Coronary Syndrome a Nation Wide Study

Endocrine Practice ◽

10.1016/s1530-891x(20)39413-1 ◽

2020 ◽

Vol 26 ◽

pp. 169

Author(s):

Umar Sharif Khawaja

Keyword(s):

Acute Coronary Syndrome ◽

Obesity Paradox ◽

Obese Patients ◽

Coronary Syndrome

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HOSPITAL OUTCOMES IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME ACCORDING TO CLINICAL PRACTICE

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2019-8-1-23-29 ◽

2019 ◽

Vol 8 (1) ◽

pp. 23-29

Author(s):

M. A. Sinkov ◽

N. A. Kochergin ◽

V. I. Ganyukov

Keyword(s):

Acute Coronary Syndrome ◽

Observational Study ◽

Hospital Mortality ◽

Hospital Admissions ◽

Treatment Strategies ◽

Invasive Treatment ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Elevation Acute Coronary Syndrome

Background. Non-ST elevation acute coronary syndrome (NSTE-ACS) is a common cause of hospital admissions of coronary artery disease patients.Aim. To assess clinical and epidemiological patterns and hospital outcomes of treatment of NSTE-ACS in Kemerovo in period from 2015 to 2017.Methods. 4884 patients with NSTE-ACS admitted to the Kemerovo healthcare facilities in the period from 2015 to 2017 were included in a retrospective observational study. In-hospital period was subjected to the analysis.Results. The morbidity of NSTE-ACS increased by 16.92% (from 267.78 cases in 2015 to 302.13 cases per 100 thousand population in 2017). The rate of invasive treatment strategies in patients with NSTE-ACS did not change significantly within the study period (about 33%). In-hospital mortality from NSTE-ACS slightly decreased (from 3.74% in 2015 to 3.21% in 2017, p = 0.681).Conclusion. The observational study reported a tendency towards increasing prevalence of NSTE-ACS in a large industrial center within the 3-year period by 16.92%. Nevertheless, the availability of invasive treatment in Kemerovo within the study period remained high (33%). However, relatively high in-hospital mortality rate (3.36%) in NSTEMI has been determined and requires additional studies.

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In hospital Mortality and correlates among patients admitted for Acute Coronary Syndrome in South India

MedPulse International Journal of Medicine ◽

10.26611/1021831 ◽

2018 ◽

Vol 8 (3) ◽

Author(s):

Vinoth Khanna ◽

◽

Priya Anbarasan ◽

Abhinaya Shanmugasundaram ◽

◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

South India ◽

Coronary Syndrome

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Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽

10.3390/molecules26041108 ◽

2021 ◽

Vol 26 (4) ◽

pp. 1108

Author(s):

Admira Bilalic ◽

Tina Ticinovic Kurir ◽

Marko Kumric ◽

Josip A. Borovac ◽

Andrija Matetic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

High Risk ◽

Hospital Mortality ◽

Vascular Calcification ◽

Matrix Gla Protein ◽

St Elevation Myocardial Infarction ◽

Coronary Syndrome ◽

Increased Risk ◽

St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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Global effect of COVID-19 pandemic on the rate of acute coronary syndrome admissions: a comprehensive review of published literature

Open Heart ◽

10.1136/openhrt-2021-001645 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001645

Author(s):

Ayman Helal ◽

Lamis Shahin ◽

Mahmoud Abdelsalam ◽

Mokhtar Ibrahim

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Admissions ◽

Absolute Risk ◽

Pearson Correlation ◽

Absolute Risk Reduction ◽

Healthcare Systems ◽

Global Effect ◽

Coronary Syndrome ◽

Admission Data ◽

St Elevation

BackgroundThe COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly.ObjectivesThe purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country.MethodSearch engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions.ResultsA total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175).ConclusionThere was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.

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