TY - JOUR
T1 - Association of body mass index and long-term outcomes in older patients with non-ST-segment-elevation myocardial infarction results from the CRUSADE registry
AU - O'Brien, Emily C.
AU - Fosbol, Emil L.
AU - Peng, S. Andrew
AU - Alexander, Karen P.
AU - Roe, Matthew T.
AU - Peterson, Eric D.
PY - 2014/1
Y1 - 2014/1
N2 - Background-Prior studies have found that obese patients have paradoxically lower in-hospital mortality after non-STsegment- elevation myocardial infarction than their normal-weight counterparts, yet whether these associations persist long term is unknown. Methods and Results-We linked detailed clinical data for patients with non-ST-segment-elevation myocardial infarction aged =65 years in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Registry to Medicare claims data to obtain longitudinal outcomes. Using height and weight measured on admission, patients were categorized into 6 body mass index (BMI [kilograms per meter squared]) groups. Multivariable Cox proportional hazards models were used to estimate the association between BMI and (1) all-cause mortality, (2) all-cause readmission, (3) cardiovascular readmission, and (4) noncardiovascular readmission for 3 years after hospital discharge. Among older patients with non-ST-segment-elevation myocardial infarction (n=34 465), 36.3% were overweight and 27.7% were obese. Obese patients were younger and more likely to have hypertension, diabetes mellitus, and dyslipidemia than normal or underweight patients. Relative to normal-weight patients, long-term mortality was lower for patients classified as overweight (BMI, 25.0-29.9), obese class I (BMI, 30.0-34.9), and obese class II (BMI, 35.0-39.9), but not obese class III (BMI =40.0). In contrast, 3-year all-cause and cardiovascular readmission were similar across BMI categories. Relative to normal-weight patients, noncardiovascular readmissions were similar for obese class I but higher for obese class II and obese class III. Conclusions-All-cause long-term mortality was generally lower for overweight and obese older patients after non-STsegment- elevation myocardial infarction relative to those with normal weight. Longitudinal readmissions were similar or higher with increasing BMI.
AB - Background-Prior studies have found that obese patients have paradoxically lower in-hospital mortality after non-STsegment- elevation myocardial infarction than their normal-weight counterparts, yet whether these associations persist long term is unknown. Methods and Results-We linked detailed clinical data for patients with non-ST-segment-elevation myocardial infarction aged =65 years in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Registry to Medicare claims data to obtain longitudinal outcomes. Using height and weight measured on admission, patients were categorized into 6 body mass index (BMI [kilograms per meter squared]) groups. Multivariable Cox proportional hazards models were used to estimate the association between BMI and (1) all-cause mortality, (2) all-cause readmission, (3) cardiovascular readmission, and (4) noncardiovascular readmission for 3 years after hospital discharge. Among older patients with non-ST-segment-elevation myocardial infarction (n=34 465), 36.3% were overweight and 27.7% were obese. Obese patients were younger and more likely to have hypertension, diabetes mellitus, and dyslipidemia than normal or underweight patients. Relative to normal-weight patients, long-term mortality was lower for patients classified as overweight (BMI, 25.0-29.9), obese class I (BMI, 30.0-34.9), and obese class II (BMI, 35.0-39.9), but not obese class III (BMI =40.0). In contrast, 3-year all-cause and cardiovascular readmission were similar across BMI categories. Relative to normal-weight patients, noncardiovascular readmissions were similar for obese class I but higher for obese class II and obese class III. Conclusions-All-cause long-term mortality was generally lower for overweight and obese older patients after non-STsegment- elevation myocardial infarction relative to those with normal weight. Longitudinal readmissions were similar or higher with increasing BMI.
KW - Acute coronary syndrome
KW - Obesity
UR - http://www.scopus.com/inward/record.url?scp=84898734245&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898734245&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.113.000421
DO - 10.1161/CIRCOUTCOMES.113.000421
M3 - Article
C2 - 24326936
AN - SCOPUS:84898734245
SN - 1941-7713
VL - 7
SP - 102
EP - 109
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 1
ER -