Relationship Between Body Mass Index and Prognosis of Patients Presenting With Potential Acute Coronary Syndromes

Objectives Studies examining the relationship between obesity and acute coronary syndrome (ACS) have been limited to patients with confirmed diagnoses. The authors sought to determine the relationship between body mass index (BMI) and 30-day cardiovascular events in emergency department (ED) patients with potential ACS. Methods This was a secondary analysis of a prospective cohort study of patients who presented to the ED with potential ACS. Patients were stratified according to their BMI: underweight (BMI 35 kg/m2). The primary outcome was acute myocardial infarction (AMI), death, or revascularization within 30 days of presentation. A logistic regression analysis was used to adjust for confounding variables and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) are presented for cardiac events and readmission outcomes. Results Of the 3,946 patients included in this study, 73 (1.9%) were underweight, 911 (23%) were normal weight, 1,199 (30.4%) were overweight, 872 (22.1%) were obese, and 891 (22.6%) were very obese. Although increased levels of obesity were associated with a greater number of cardiac risk factors, there was no difference in 30-day cardiovascular events between those of normal weight and underweight (aOR = 1.1; 95% CI = 0.4 to 2.7), overweight (aOR = 1.0; 95% CI = 0.7 to 1.4), obese (aOR = 1.2; 95% CI = 0.8 to1.7), or very obese (aOR = 0.8; 95% CI = 0.5 to 1.3). Those who were underweight were more likely to be readmitted within 30 days (aOR = 1.9; 95% CI = 1.0 to 3.7), and those who were very obese were less likely to be readmitted within 30 days (aOR = 0.7; 95% CI = 0.5 to 0.9). Conclusions Among patients who present to the ED with potential ACS, BMI is not associated with higher risk of cardiovascular outcomes at 30 days. Resumen Relacion entre el Indice de Masa Corporal y el Pronostico de los Pacientes que Consultan por un Potencial Sindrome Coronario Agudo Objetivos Los estudios que examinan la relacion entre la obesidad y el sindrome coronario agudo (SCA) se han limitado a pacientes con el diagnostico confirmado. Los autores investigan la relacion entre el indice de masa corporal (IMC) y los eventos cardiovasculares durante los 30 dias siguientes en los pacientes con un potencial SCA que consultan en el servicio de urgencias (SU). Metodologia Analisis secundario de un estudio de cohorte prospectivo de pacientes que acudieron al SU con un potencial SCA. Los pacientes fueron clasificados acorde a su IMC: peso bajo (IMC 35 kg/m2). El resultado principal fue el infarto agudo de miocardio (IAM), la muerte o la revascularizacion en los primeros 30 dias tras la visita. Se utilizo un analisis de regresion logistica para ajustar las variables de confusion y se presentaron las razones de ventajas ajustadas (ORa) con los intervalos de confianza (IC) del 95% para los eventos cardiacos y los resultados de reingreso. Resultados De los 3.946 pacientes incluidos en este estudio, 73 (1,9%) fueron de bajo peso, 911 (23%) de peso normal, 1.199 (30,4%) con sobrepeso, 872 (22,1%) obesos y 891 (22.6%) muy obesos. Aunque los niveles elevados de obesidad se asociaron con un mayor numero de factores de riesgo cardiovasculares, no hubo diferencias en los eventos cardiovasculares a los 30 dias entre aquellos con peso normal y bajo peso (ORa 1,1; IC 95% = 0,4 a 2,7), sobrepeso (ORa 1,0; IC 95% = 0,7 a 1,4), obesos (ORa 1,2; IC 95% = 0,8 a 1,7), o muy obesos (ORa 0,8; IC 95% = 0,5 a 1,3). Aquellos que tenian bajo peso tuvieron mayor probabilidad de ser reingresados en los 30 dias siguientes (ORa 1,9; IC 95% = 1,0 a 3,7), y aquellos que fueron muy obesos tuvieron menor probabilidad (ORa 0,7; IC 95% = 0,5 a 0,9). Conclusiones En los pacientes que acuden al SU con un potencial SCA, el IMC no esta asociado con un mayor riesgo de resultados cardiovasculares adversos a los 30 dias.