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/m 2 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/m 2 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.