Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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
BACKGROUND
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.
AIM
To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
