Published online Jan 26, 2020. doi: 10.4330/wjc.v12.i1.44
Peer-review started: July 17, 2019
First decision: August 20, 2019
Revised: November 15, 2019
Accepted: November 25, 2019
Article in press: November 25, 2019
Published online: January 26, 2020
Processing time: 173 Days and 4.5 Hours
ST-elevation myocardial infarction (STEMI) remains a major cause of mortality despite early revascularization and optimal medical therapy. Tailoring individual management by considering patients’ specificities may help in improving post-STEMI survival.
To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.
We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort, “Registre d’Infarctus Maine-Anjou”. Bleeding Academic Research Consortium (BARC) in-hospital bleeding complications were recorded.
Of 705 patients (35.3%) were presented as being of normal weight, defined as a body mass index (BMI) < 25 kg/m², 877 (43.9%) had a BMI between 25 and 30 kg/m² and 416 (20.8%) had a BMI ≥ 30 kg/m². One-year cardiovascular mortality was lower for BMI ≥ 25 kg/m² (5.3% and 7.1%) patients than for normal weight patients (10.8%) (P = 0.001). We found an interaction between the effect of BARC 3 on mortality and BMI groups. While a BARC 3 was related to a higher 1-year mortality in general (HR: 2.58, 95%CI: 1.44-4.64, P ≤ 0.001), prognosis was even worse in normal weight patients (HR: 2.97, 95%CI: 1.61-5.5, P < 0.001) than for patients with a BMI ≥ 25 kg/m² (HR: 1.94, 95%CI: 1.02-3.69, P = 0.041).
Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI. Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.
Core tip: There was an obesity paradox, with body mass index (BMI) ≥ 25 kg/m² ST-elevation myocardial infarction patients presenting better survival. Normal weight patients presented more in-hospital bleeding than others. In-hospital bleeding was related to 1-year cardiovascular mortality. Presenting a normal BMI increased the effect of bleeding on mortality.