OR06-8
Obesity Paradox In Patients With Non‐ST‐Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Nationwide Retrospective Observational Study
Aditya Thakkar, East Tennessee State University, Johnson City, TN
Aditya Thakkar1, Soumya Gupta2, Venkata Vedantam1 and Rupal Shah1, (1)East Tennessee State University, Johnson City, TN, (2)Icahn School of Medicine at Mount Sinai, New York, NY
Keywords: Acute Coronary Syndromes (ACS), Coronary, Drug-coated Balloon (DCB) and Drug-eluting Stent (DES)
Background
The prevalence of obesity in the USA is high with over 35% of the population being categorized as obese. Obesity and the lifestyle leading up to it is considered to be a huge risk factor for heart disease. Nevertheless, research studies have found controversial outcomes on 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 and not obese. 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
448,424 hospitalizations with NSTEMI were analyzed of which 172,665 underwent PCI. Among them, 39,548 (22.9%) were considered obese. This included patients with a body mass index greater than 30. This particular group was associated with lower in-hospital mortality (1.2% vs 1.8%, aOR: 0.82; 95% CI: 0.74-0.90, p<0.001); when adjusted for age, race, sex, and Charlson comorbidity index. Furthermore, they had a lower risk 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 lower life-saving treatments like blood transfusions (1.9% vs 2.3%, aOR:0.90; 95% CI: 0.83-0.98, p <0.05) and ventilators (2.9% vs 3.2%, aOR:0.91, 95% CI: 0.85-0.98, p <0.05). There was no statistically significant difference in dialysis, pressors, or ECMO utilization. On the other hand, obesity was associated with more acute renal failure(9.1% vs 8.2%, aOR:1.25, 95% CI:1.20-1.29, p<0.001). Conclusions
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.