International journal of cardiology · 2026
Impact of obesity on 1-year major adverse cardiac events after primary PCI for STEMI.
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Simioni Lisa, Loureiro Tania, Faucherre Yannick, Cioffi Giacomo Maria, Jelisejevas Julius, Bennar Wesley, Beretta Giulia S, Puricel Serban, Meier Pascal, Togni Mario, Cook Stéphane, Skalidis Ioannis
Аннотация
BACKGROUND: Obesity is increasing in all regions of Switzerland. Multiple studies have described the "obesity paradox" suggesting a protective effect of obesity on the occurrence of major adverse cardiovascular events (MACE) after ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).
OBJECTIVE: This study aimed to assess the impact of obesity on MACE in STEMI patients undergoing PCI.
METHODS: We analyzed data from the Fribourg STEMI Fast-Track prospective registry in a retrospective, single-center cohort study. Adult patients were classified as obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2) and followed for 12 months. The primary endpoint was a composite MACE including all-cause death, recurrent acute coronary syndrome (ACS) (STEMI, NSTEMI and unstable angina (UA)), stroke, stent thrombosis, unscheduled revascularisation, and major bleeding (BARC 3-5). Secondary endpoints included stratification according three obesity stages to evaluate 1-year MACE-free survival, as well as assessment of individual MACE components, delays in care, mode of presentation, and clinical and procedural characteristics. Kaplan-Meier analysis with log-rank testing and Cox regression were used to evaluate outcomes.
RESULTS: A total of 1043 patients were included between June 2008 and October 2025, of whom 214 (21%) were obese and 829 (79%) were non-obese. Obese patients were slightly younger (60.00 (53.00, 70.00) vs 62.00 (53.00, 72.00) years, p = 0.037), with a similar proportion of women (21% vs 25%, p = 0.299). At 12 months, MACE-free survival was similar between groups (log-rank p = 0.76), and obesity was not associated with MACE after adjustment. No differences were observed in individual components of the composite endpoint. Pre-hospital delay was comparable, whereas first medical contact-to-revascularisation (FMC-to-REVASC) time was longer in obese patients (0.78 vs 0.57 h, p < 0.001), with no difference in total ischemic time. Obese patients were less likely to present via ambulance (31% vs 38%) and more likely to self-present to the emergency department (32% vs 24%; p = 0.037). Clinical presentation, procedural characteristics, and coronary anatomy were similar between groups.
CONCLUSIONS: In this contemporary STEMI cohort, obese patients treated with primary PCI did not experience higher 1-year MACE rates than non-obese patients. However, obesity was associated with differences in care pathways and longer in-hospital delays, without impact on clinical outcomes.
OBJECTIVE: This study aimed to assess the impact of obesity on MACE in STEMI patients undergoing PCI.
METHODS: We analyzed data from the Fribourg STEMI Fast-Track prospective registry in a retrospective, single-center cohort study. Adult patients were classified as obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2) and followed for 12 months. The primary endpoint was a composite MACE including all-cause death, recurrent acute coronary syndrome (ACS) (STEMI, NSTEMI and unstable angina (UA)), stroke, stent thrombosis, unscheduled revascularisation, and major bleeding (BARC 3-5). Secondary endpoints included stratification according three obesity stages to evaluate 1-year MACE-free survival, as well as assessment of individual MACE components, delays in care, mode of presentation, and clinical and procedural characteristics. Kaplan-Meier analysis with log-rank testing and Cox regression were used to evaluate outcomes.
RESULTS: A total of 1043 patients were included between June 2008 and October 2025, of whom 214 (21%) were obese and 829 (79%) were non-obese. Obese patients were slightly younger (60.00 (53.00, 70.00) vs 62.00 (53.00, 72.00) years, p = 0.037), with a similar proportion of women (21% vs 25%, p = 0.299). At 12 months, MACE-free survival was similar between groups (log-rank p = 0.76), and obesity was not associated with MACE after adjustment. No differences were observed in individual components of the composite endpoint. Pre-hospital delay was comparable, whereas first medical contact-to-revascularisation (FMC-to-REVASC) time was longer in obese patients (0.78 vs 0.57 h, p < 0.001), with no difference in total ischemic time. Obese patients were less likely to present via ambulance (31% vs 38%) and more likely to self-present to the emergency department (32% vs 24%; p = 0.037). Clinical presentation, procedural characteristics, and coronary anatomy were similar between groups.
CONCLUSIONS: In this contemporary STEMI cohort, obese patients treated with primary PCI did not experience higher 1-year MACE rates than non-obese patients. However, obesity was associated with differences in care pathways and longer in-hospital delays, without impact on clinical outcomes.