麻豆传媒

Background

The obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our study aims to evaluate the in-hospital outcomes of percutaneous coronary intervention (PCI) in metabolically healthy individuals with obesity (MHO) and metabolically unhealthy (MUHO) individuals with obesity over 65 years of age with acute coronary syndrome (ACS) between 2016 and 2020.

Methods

This was a retrospective and observational study. Patients were identified through utilizing the National Inpatient Sample (NIS) Database (2016–2020) and ICD-10 codes. By employing a t-test and Pearson's Chi-square test, we assessed and contrasted the initial attributes, concurrent conditions, and results pertaining to all-cause mortality (ACM), cardiogenic shock (CS), length of stay (LOS), and hospitalization expense. Moreover, propensity score matching was conducted in a 1:1 ratio with respect to age, gender, and race. We also utilized multivariable logistic regression to compare MHO and MUHO in terms of the impact on all-cause mortality.

Results

Out of a total of 135,395 patients identified, 2,995 patients with MUHO were matched with 2,995 MHO patients. Patients in the MUHO group had a higher prevalence of chronic pulmonary disease (24.9% vs 19.5%), peripheral vascular disease (9.3% vs 6.7%), hypothyroidism (16% vs 11.5%), prior myocardial infarction (15.9% vs 6.2 %), and prior stroke (7.5% vs 2.8%). Patients in the MHO group had a higher ACM (12.4% vs 2.8%, P<0.001), cardiogenic shock (18.55% vs 7%, P<0.001), stroke (2.2% vs 1%, P<0.001), ventricular assist device insertions (5.2% vs 2.7%, P<0.001), and intra-aortic balloon pump insertions (IABPs) (8.8% vs 3.8%) compared with the MUHO cohort.

Conclusion

Our study revealed an obesity paradox in individuals over 65 years of age undergoing PCI demonstrating worse outcomes, including higher in-hospital mortality, CS, stroke, Ventricular assist device and IABP insertion in MHO patients compared to the MUHO cohort.

Read an interview about the study here.