Obesity paradox: a myth or reality, time to reveal the fact in a South Asian cohort presenting with STE-ACS undergoing primary percutaneous coronary intervention

Abstract

Objectives Obesity is a globally well-established risk factor for atherosclerotic cardiovascular diseases; however, some studies have witnessed survival benefits among obese patients and this phenomenon is termed ‘the obesity paradox’. Our aim was to evaluate the existence of an obesity paradox in patients with ‘ST-elevation acute coronary syndrome (STE-ACS)’ in our population.Methods In this observational study, we included patients presenting with STE-ACS undergoing primary percutaneous coronary intervention (PCI). Body mass index (BMI) ‘(weight (kg)/height (m)2) was calculated and patients with BMI ≥30 kg/m2 were categorised as obese. All the patients were observed during their hospital stay for postprocedure in-hospital morbidity (pump failure, contrast-induced nephropathy, major bleeding, cerebrovascular accident/stroke, access site complications or stent thrombosis) and mortality.Results A total of 1099 patients were included, out of which 78% (857) were men, and mean age was 54.66±10.9 years. The mean BMI was 27.48±4.93 kg/m2 and 23.2% (255) were categorised as obese. The in-hospital morbidity rate was 13.4% (113/844) vs 8.6% (22/255); p=0.042 and in-hospital mortality rate was 1.9% (16/844) vs 4.7% (12/255); p=0.013 for non-obese and obese patients, respectively. On multivariable analysis, obesity showed paradoxical protective effect with adjusted OR of 0.59 (95% CI 0.36 to 0.96, p=0.033) for postprocedure in-hospital morbidity. However, obesity was found to be an independent predictor of in-hospital mortality with an adjusted OR of 3.13 (95% CI 1.37 to 7.15, p=0.007).Conclusion In conclusion, we have found evidence of the obesity paradox in in-hospital morbidity, but not in mortality, after primary PCI of patients with ST-ACS in our population.