American heart journal plus : cardiology research and practice · 2026
Obesity paradox in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention: A nationwide retrospective observational study.
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Moore Sean, Thakkar Aditya, Notta Shahnawaz, Snipp Jacob, McGuire Colin, Vedantam Venkata, Jbara Manar H
Аннотация
INTRODUCTION: The prevalence of obesity in the United States is high, with over 35% of the population classified as obese. Obesity, along with the lifestyle factors contributing to it, is considered a major risk factor for heart disease. However, research studies have reported controversial findings regarding its impact on morbidity and mortality.
METHODS: Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included adult patients with a principal discharge diagnosis of NSTEMI who underwent PCI during hospitalization. They were divided into obese (BMI > 30) and not obese (BMI < 30). The primary outcome was inpatient mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, arrhythmias, and acute renal failure, as well as the need for transfusions, pressors, ventilators, and ECMO.
RESULTS: We analyzed 448,424 hospitalizations for NSTEMI, of which 172,665 patients underwent PCI. Among these, 39,548 (22.9%) were obese (BMI >30). Obesity was associated with lower in-hospital mortality compared to non-obese patients (1.2% vs. 1.8%; adjusted odds ratio [aOR]: 0.82; 95% CI: 0.74-0.90; p < 0.001), after adjustment for age, sex, race, and Charlson Comorbidity Index. Obese patients also had lower rates of cardiogenic shock (2.7% vs. 3.3%; aOR: 0.84; 95% CI: 0.78-0.90; p < 0.001), cardiac arrest (1.3% vs. 1.6%; aOR: 0.86; 95% CI: 0.78-0.95; p < 0.005), and ventricular arrhythmias (5.2% vs. 5.7%; aOR: 0.93; 95% CI: 0.88-0.98; p < 0.005). They also required fewer blood transfusions (1.9% vs. 2.3%; aOR: 0.90; 95% CI: 0.83-0.98; p < 0.05) and mechanical ventilation (2.9% vs. 3.2%; aOR: 0.91; 95% CI: 0.85-0.98; p < 0.05). No significant differences were observed in dialysis, vasopressor use, or ECMO. However, obese patients had higher rates of acute kidney injury (15.0% vs. 13.5%; aOR: 1.25; 95% CI: 1.21-1.29; p < 0.001) and acute respiratory failure (9.1% vs. 8.2%; aOR: 1.17; 95% CI: 1.13-1.23; p < 0.001).
CONCLUSION: The "obesity paradox" suggests that despite obesity's role in cardiovascular disease risk, individuals with obesity may have a survival advantage during acute cardiovascular events and certain surgeries. Our study aligns with these findings, underscoring the need for further research to comprehend the underlying pathophysiological mechanisms.
METHODS: Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included adult patients with a principal discharge diagnosis of NSTEMI who underwent PCI during hospitalization. They were divided into obese (BMI > 30) and not obese (BMI < 30). The primary outcome was inpatient mortality. Secondary outcomes were cardiogenic shock, cardiac arrest, arrhythmias, and acute renal failure, as well as the need for transfusions, pressors, ventilators, and ECMO.
RESULTS: We analyzed 448,424 hospitalizations for NSTEMI, of which 172,665 patients underwent PCI. Among these, 39,548 (22.9%) were obese (BMI >30). Obesity was associated with lower in-hospital mortality compared to non-obese patients (1.2% vs. 1.8%; adjusted odds ratio [aOR]: 0.82; 95% CI: 0.74-0.90; p < 0.001), after adjustment for age, sex, race, and Charlson Comorbidity Index. Obese patients also had lower rates of cardiogenic shock (2.7% vs. 3.3%; aOR: 0.84; 95% CI: 0.78-0.90; p < 0.001), cardiac arrest (1.3% vs. 1.6%; aOR: 0.86; 95% CI: 0.78-0.95; p < 0.005), and ventricular arrhythmias (5.2% vs. 5.7%; aOR: 0.93; 95% CI: 0.88-0.98; p < 0.005). They also required fewer blood transfusions (1.9% vs. 2.3%; aOR: 0.90; 95% CI: 0.83-0.98; p < 0.05) and mechanical ventilation (2.9% vs. 3.2%; aOR: 0.91; 95% CI: 0.85-0.98; p < 0.05). No significant differences were observed in dialysis, vasopressor use, or ECMO. However, obese patients had higher rates of acute kidney injury (15.0% vs. 13.5%; aOR: 1.25; 95% CI: 1.21-1.29; p < 0.001) and acute respiratory failure (9.1% vs. 8.2%; aOR: 1.17; 95% CI: 1.13-1.23; p < 0.001).
CONCLUSION: The "obesity paradox" suggests that despite obesity's role in cardiovascular disease risk, individuals with obesity may have a survival advantage during acute cardiovascular events and certain surgeries. Our study aligns with these findings, underscoring the need for further research to comprehend the underlying pathophysiological mechanisms.