Association of Obesity and Cardiovascular Outcomes in Myocardial Infarction

Study Overview
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Brief Summary
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In this study, the investigators evaluated the association between various measures of adiposity [BMI and waist circumference (WC)] and clinical outcomes in Asian patients with Myocardial Infarction who underwent percutaneous coronary intervention or bypass surgery, using a nationwide population based cohort.

Detailed Description
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This retrospective nationwide cohort study used administrative claims data from the Korean National Health Insurance Service (NHIS) and the combined health check-up database of the National Health Insurance Corporation between 2013 and 2020. The investigators included patients newly diagnosed with MI and underwent revascularization (PCI or CABG) between January 2015 and December 2020. Patients aged <20 years, those who were already diagnosed with MI before 2015, and those with cancer were excluded from the analysis. The follow-up period was defined as the time from the index date (date of diagnosis) to each outcome event, date of death, or end of the study period (December 31, 2020), whichever came first. Patients' demographic data, comorbidities, concomitant medications, and income level were collected from the Korean NHIS database. The recent health check-up data from the index date was also ascertained, including height, weight, waist circumference, blood pressure, health surveys, and laboratory exam. Health survey included family history, smoking history, alcohol history, and the level of individual physical activity. According to BMI following the World Health Organization recommendation for Asian population, study patients were categorized into 5 groups: underweight, <18.5 kg/m2; normal range, 18.5 to <23 kg/m2; overweight, 23 to <25 kg/m2; obese I, 25 to <30 kg/m2; and obese II, ≥30 kg/m2[4]. The investigators defined the proportion of medical use by calculating formula with the recuperation cost and the number of the visit to hospitals. During the follow-up period, The investigators assessed 3 clinical outcomes, including all-cause death, cardiovascular hospitalization and the recurrence rate. Clinical outcomes were mainly defined by the the International Classification of Diseases, 10th revision (ICD-10). Patients were censored at the clinical outcomes or the end of the study period (December 31, 2020), whichever came first. All categorical variables are presented as frequencies and percentages. Normally distributed data were presented as mean ± standard deviation, whereas nonparametric data are presented as median and interquartile range by BMI. Cox proportional hazard regression analyses were performed to identify the association of BMI with the primary and secondary outcomes, calculating hazard ratio (HR) and 95% confidence interval (CI) and adjusting for the following potential confounders: sex, age, systolic blood pressure, fasting glucose level, total cholesterol level, alcohol consumption, smoking status, physical activity, household income, use of antihypertensive agents, use of statins, use of antiplatelet agents, previous history of MI, previous history of stroke, and index year. All analyses were conducted using R-statistics.

Official Title
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Association of Obesity and Cardiovascular Outcomes in Patients With Myocardial Infarction : a Korean Nationwide Cohort Study

Conditions
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Obesity Associated Disorder, Myocardial Infarction

Intervention / Treatment
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* Procedure: Percutaneous coronary intervention (PCI)
* Procedure: Coronary artery bypass grafting (CABG)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients newly diagnosed with MI and underwent revascularization (PCI or CABG) between January 2015 and December 2020. Exclusion Criteria: Patients aged <20 years Patients diagnosed with MI before 2015 Patients with cancer

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with MI who underwent revascularization during study period<br>Patients newly diagnosed with MI and underwent revascularization (PCI or CABG) during study period | Procedure: Percutaneous coronary intervention (PCI)<br>* Patients who underwent percutaneous coronary intervention (PCI), including percutaneous transluminal coronary angioplasty (PTCA), and coronary stent insertion<br>* Other names: Coronary intervention therapy;Procedure: Coronary artery bypass grafting (CABG)<br>* Patients who underwent coronary artery bypass grafting (CABG)<br>* Other names: Coronary graft surgery;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MACE | Thromboembolism + Death + CV hospitalization | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Thromboembolism | Recurrent myocardial infarction, Stroke | 5 years | 
| Death | Mortality | 5 years | 
| CV hospitalization | Admission caused by Cardiovacular disease | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Obesity paradox, Myocardial infarction