European Heart Journal Advance Access originally published online on October 13, 2006
European Heart Journal 2007 28(4):415-424; doi:10.1093/eurheartj/ehl329
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The impact of anthropomorphic indices on clinical outcomes in patients with acute ST-elevation myocardial infarction
1 Duke Clinical Research Institute and Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA
2 Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
3 University Hospital Leuven, Leuven, Belgium
4 University of Alberta, Edmonton, Canada
5 Case Western Reserve University, Cleveland, OH, USA
Received 9 January 2006; revised 12 September 2006; accepted 28 September 2006; online publish-ahead-of-print 13 October 2006.
* Corresponding author. Tel: +1 919 668 8971; fax: +1 919 668 7056. E-mail address: mehta007{at}dcri.duke.edu
Aims Multiple studies have focused on the relationship of body anthropometric measures with clinical events in ST-elevation myocardial infarction (STEMI) patients, highlighting the ‘obesity paradox’. However, the relative prognostic importance of these measures over other baseline variables is less known.
Method and results We performed a retrospective analysis of 94 108 STEMI patients from seven clinical trials evaluating various reperfusion strategies to study the relationship and prognostic importance of height, weight, body mass index (BMI), and body surface area (BSA) with 30-day death and in-hospital cardiogenic shock, major bleeding, and stroke. Main outcome measures of interest included 30-day death and in-hospital cardiogenic shock, major bleeding, and stroke. Weight, BMI, and BSA were inversely and independently related to all clinical events. Despite being statistically significant (P < 0.0001), the prognostic information contributed by weight beyond that conferred by baseline clinical factors was minimal (<1% of total prognostic information) making it of limited clinical relevance for predicting 30-day death and cardiogenic shock. In contrast, weight accounted for 8.4% and 4.3% of the prognostic information in the logistic regression models for major bleeding and for stroke. BMI or BSA added little incremental value over simple measure of weight.
Conclusion Although statistically significantly related to most outcomes in patients with STEMI including death and shock, body weight provided clinically relevant prognostic information only for the risk of major bleeding and of stroke. Furthermore, BMI or BSA contributed little incremental prognostic information beyond that provided by weight alone. Thus, the existing large body of information concerning the strong prognostic importance of anthropometric measures with outcomes after STEMI should be interpreted in the context of other more important risk factors.
Key Words: Acute myocardial infarction • Weight • Outcomes • Reperfusion
This paper was guest-edited by Prof. Elliott Marshall Antman, Brigham and Women's Hospital, Boston, USA
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