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Prognostic significance of obesity after ST-elevation myocardial infarction: the impact on heart failure

Session Poster Session 1

Speaker Ricardo Costa

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : R Costa (Porto,PT), R Santos (Porto,PT), M Trepa (Porto,PT), S Vieira (Porto,PT), M Santos (Porto,PT), M Oliveira (Porto,PT), A Frias (Porto,PT), A Luz (Porto,PT), M Santos (Porto,PT), S Torres (Porto,PT)

Authors:
R Costa1 , R Santos1 , M Trepa1 , S Vieira2 , M Santos2 , M Oliveira1 , A Frias1 , A Luz1 , M Santos1 , S Torres1 , 1Hospital Center of Porto, Cardiology - Porto - Portugal , 2Abel Salazar Institute of Biomedical Sciences - Porto - Portugal ,

Citation:

Introduction: In general population, a normal range body mass index (BMI) is associated with lower mortality. Paradoxically, in several chronic diseases an increased BMI is related to better prognosis, including in post-acute coronary syndrome patients.

Purpose: We aimed to evaluate the relation between BMI and cardiovascular outcomes in a cohort of ST-elevation myocardial infarction (STEMI) patients.

Methods: We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention at a tertiary hospital between 1st January 2010 and 31st December 2016. Clinical and outcome data were retrieved by chart review. BMI was categorized as low weight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25- 29.9 kg/m2) and obese (=30 kg/m2). Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as occurrence of cardiovascular death, myocardial infarction, stroke or target lesion revascularization. Heart failure (HF)-related events were defined as de novo HF diagnosis, clinical worsening HF (increased dose of diuretics at outpatient clinic) or HF hospitalization.

Results: We included 864 patients (63±13 years, 75% male), 0.6% with low weight, 33.3% with normal weight, 45.1% overweight and 16.1% obese. Obese were younger and exhibited higher prevalence of previous hypertension, diabetes and dyslipidemia. Incidence of MACCE was 20.1%, with a median time to event of 10.1 [1.3-255.1] days and no significant differences between BMI groups. In multivariate analysis, only left ventricular ejection fraction (LVEF; if preserved, HR 0.45, 95 CI 0.23-086) and previous history of hypertension (HR 2.77, 95 CI 1.43-5.39) were independent predictors of MACCE. The overall post-STEMI HF-related events was 18.2% (6.2% de novo HF, 2.7% HF worsening and 9.3% HF hospitalization) with a median time to event of 10.8 [2.4-32.4] months. Independent predictors of HF-related events were age (HR 1.05, 95 CI 1.03-1.08), diabetes (HR 1.94, 95 CI 1.17-3.20), Killip-Kimball class (HR 3.02, 95 CI 1.96-5.25), LVEF (if preserved, HR 0.46, 95 CI 0.27-0.79) and obesity (HR 2.43, 95 CI 1.19-4.96).

Conclusion: In a cohort of all-comers STEMI patients, BMI was not associated with MACCE. In contrast, obese patients had an increased risk of developing de novo HF or worsening of preexistent HF. Our data suggests that obesity has a divergent prognostic significance regarding cardiovascular outcomes.

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