Ingremeau D, Grall S, Valliet F, Desprets L, Prunier F, Furber A, Bière L. Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction.
World J Cardiol 2020;
12:44-54. [PMID:
31984127 PMCID:
PMC6952721 DOI:
10.4330/wjc.v12.i1.44]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND
ST-elevation myocardial infarction (STEMI) remains a major cause of mortality despite early revascularization and optimal medical therapy. Tailoring individual management by considering patients’ specificities may help in improving post-STEMI survival.
AIM
To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.
METHODS
We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort, “Registre d’Infarctus Maine-Anjou”. Bleeding Academic Research Consortium (BARC) in-hospital bleeding complications were recorded.
RESULTS
Of 705 patients (35.3%) were presented as being of normal weight, defined as a body mass index (BMI) < 25 kg/m², 877 (43.9%) had a BMI between 25 and 30 kg/m² and 416 (20.8%) had a BMI ≥ 30 kg/m². One-year cardiovascular mortality was lower for BMI ≥ 25 kg/m² (5.3% and 7.1%) patients than for normal weight patients (10.8%) (P = 0.001). We found an interaction between the effect of BARC 3 on mortality and BMI groups. While a BARC 3 was related to a higher 1-year mortality in general (HR: 2.58, 95%CI: 1.44-4.64, P ≤ 0.001), prognosis was even worse in normal weight patients (HR: 2.97, 95%CI: 1.61-5.5, P < 0.001) than for patients with a BMI ≥ 25 kg/m² (HR: 1.94, 95%CI: 1.02-3.69, P = 0.041).
CONCLUSION
Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI. Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.
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