Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2020; 12(1): 44-54
Published online Jan 26, 2020. doi: 10.4330/wjc.v12.i1.44
Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction
Delphine Ingremeau, Sylvain Grall, Florine Valliet, Laurent Desprets, Fabrice Prunier, Alain Furber, Loïc Bière
Delphine Ingremeau, Sylvain Grall, Fabrice Prunier, Alain Furber, Loïc Bière, Department of Cardiology, Angers University Hospital, Angers 49933, France
Sylvain Grall, Fabrice Prunier, Alain Furber, Loïc Bière, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, University of Angers, Angers 49100, France
Florine Valliet, Department of Cardiology, Saumur Hospital, Saumur 49403, France
Laurent Desprets, Department of Cardiology, Cholet Hospital, Cholet 49300, France
Author contributions: Furber A, Ingremeau D and Biere L designed the research; Ingremeau D, Grall S, Desprets L and Valliet F performed the research; Ingremeau D and Biere L analyzed the data; Ingremeau D wrote the paper; Prunier F and Furber A provided scientific review.
Institutional review board statement: The study was reviewed and approved by the University Hospital of Angers Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided informed oral consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Loïc Bière, MD, PhD, Assistant Professor, Associate Professor, Doctor, Senior Scientist, Department of Cardiology, Angers University Hospital, Institut MitoVasc, 3 rue Roger Amsler, Angers 49933, France. lobiere@chu-angers.fr
Received: July 12, 2019
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
ARTICLE HIGHLIGHTS
Research background

ST-segment 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.

Research motivation

While overweight and obesity are correlated with common cardiovascular (CV) risk factors and outcomes, overweight and obese patients present better survival after suffering from myocardial infarction. This obesity paradox is not elucidated.

Research objectives

To assess whether the obesity paradox might be explained by bleeding events after a first STEMI.

Research methods

We studied 2070 patients consecutively from the “Registre d’Infarctus Maine-Anjou” survey, that prospectively included all patients presenting with a STEMI in a Western region of France, in which the only available 24 h-7 d coronary angiography service was in Angers University Hospital. Median age was 64 (interquartile range 53-77) years, 74.3% were male, 41% presented with anterior infarction and 81% underwent primary percutaneous coronary intervention. Outcomes were gathered during the year following MI. Bleeding Academic Research Consortium (BARC) 3 and 5 bleeding events were used to assess in-hospital bleeding complications. Cox regression analyses were performed to assess correlates for 1-year mortality.

Research results

One-year CV mortality was significantly lower for body mass index (BMI) ≥ 25 kg/m² (5.3% and 7.1%) patients than for normal weight patients (10.8%) with P = 0.001. Independent variables associated with 1-year CV mortality were age, prior myocardial infarction, prior stroke, cancer, creatine phosphokinase peak, in-hospital heart failure and BARC 3 bleeding. BMI was not an independent variable in this multivariate analysis although there was an interaction between BARC 3 and BMI (HR: 2.58, 95%CI: 1.44-4.64, P = 0.001), demonstrating BARC 3 bleeding to have a stronger clinical impact among normal weight patients (HR: 2.97, 95%CI: 1.61-5.5, P < 0.001) than for BMI ≥ 25 kg/m² patients (HR: 1.94, 95%CI: 1.02-3.69, P = 0.041).

Research conclusions

We show in the present study the role that in-hospital bleeding may play in the obesity paradox. Indeed, not only in-hospital bleeding events were lower among overweight patients, but also presented a weaker impact on 1-year CV mortality. The results of this study first suggest a need to adjust antithrombotic therapies in normal weight patients. Lowering doses to lower bleeding events must be balanced with anti-ischemic efficacy. Second, the reasons why intra-hospital bleeding presents a lower impact on overweight patients raise question and need further investigation.

Research perspectives

Randomized control trials are needed to better monitor anti-thrombotic therapies in STEMI patients. Beside age, gender and clinical presentation, BMI might be a valuable feature to assess.