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Long-term follow-up (12 years) of ST-segment elevation myocardial infarction survivors in accordance to weight: Is there and obesity paradox?
Session:
Posters (Sessão 6 - Écran 7) - Enfarte miocárdio elevação ST
Speaker:
David Sá Couto
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
David Sá Couto; André Alexandre; André Luz; Andreia Campinas; André Frias; Raquel Santos; Bruno Brochado; João Silveira; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Introduction</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">: Obesity is a known risk factor for coronary artery disease. Yet, previous studies have described an “obesity paradox” reporting a protective effect of obesity in patients with cardiovascular disease. This study aims to determine whether an obesity paradox is evident over long-term follow-up among ST-segment elevation myocardial infarction (STEMI) patients.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Methods</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">: This is a retrospective study of STEMI patients admitted to primary PCI who survived until hospital discharge, between January 2008 and December 2013, followed for a 12 years period. Patients were classified according to their body mass index into normal weight (18.5-24.9 kg/m<sup>2</sup>), overweight (25-29.9 kg/m<sup>2</sup>) and obese (≥ 30 kg/m<sup>2</sup>). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE), which included a composite of cardiovascular death, stroke, acute coronary syndrome, any coronary revascularization, and heart failure hospitalization.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Results</span></span></u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">: Of 584 patients admitted, 535 (91.6%) were alive at hospital discharge. For 3 of them, weight was unknown and they were excluded. A total of 532 individuals were included in the analysis with a median follow-up of 8.01 (2.43-8.46) years. 74.2% were male and mean age was 62.2 (± 13.1) years. Regarding weight, 36.8% had normal weight, 47.2% were overweight, and 16.0% were obese. There were no significant differences between the groups regarding baseline clinical characteristics, except for hypertension and diabetes mellitus (more comon in obese patients). Regarding procedural characteristics, there were no differences between groups, except for no-reflow (more common in obese patients: 9.4% vs 3.4% p=0.020) and TIMI score (a lower median TIMI score was found in obese patients; p=0.040). Multivariate analysis with Cox regression revealed that overweight (adjusted hazard ratio (HR) 1.56, 95% CI 1.10-2.22, p=0.013) and obesity (adjusted HR 2.33, 95% CI 1.50-3.61, p<0.001) were independently associated with a higher risk of MACCE after relevant variable adjustment. Kaplan-Meier survival analysis corroborated the association (Log rank p = 0.009).</span></span></span></span></span></p> <p><u><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">Conclusion</span></span></u><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:"Times New Roman",serif">: Unlike previous published data on heart failure and coronary artery bypass patients, data from our real-world study did not confirm the existance of the “obesity paradox” during long-term follow-up of STEMI survivors. In this population, overweight and obese patients had 56% and 133% (respectively) higher risk of MACCE compared to normal weight individuals.</span></span></span></p>
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