Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction

Table 1 Baseline clinical characteristics according to body mass index

	Total	BMI < 25 kg/m²	25 ≤ BMI < 30 kg/m²	BMI ≥ 30 kg/m²	P value
	n = 1998	n = 705	n = 877	n = 416
Cardiovascular risk factors
Age (yr)	64 (53-77)	67 (53-79)ae	64 (53-76)ac	61 (51-74)ce	< 0.001
Male	1485 (74.3)	493 (69.6)a	693 (79.0)ac	302 (72.6)c	< 0.001
Hypertension	986 (49.3)	308 (43.6)e	422 (48.2)c	257 (61.9)ce	< 0.001
Diabetes mellitus	492 (24.6)	134 (19.1)ae	211 (24.3)ac	147 (35.6)ce	< 0.001
Dyslipidaemia	1001 (50.1)	323 (45.8)ae	442 (50.8)ac	236 (57.0)ce	0.001
Smoker	708 (35.4)	261 (37)ae	299 (34.2)a	148 (35.8)e	0.006
Family history of coronary artery disease	442 (22.1)	134 (19.1)ae	210 (24.4)a	98 (24.0)e	0.032
Prior myocardial infarction	171 (8.6)	53 (7.5)	83 (9.5)	35 (8.5)	0.36
Obstructive sleep apnoea	22 (1.1)	0 (0.0)ae	10 (1.5)ac	12 (3.7)ce	< 0.001
History
Stroke	86 (4.3)	34 (4.8)	37 (4.2)	15 (3.6)	0.4
Renal failure	59 (3.0)	21 (3.0)	29 (3.3)	9 (2.2)	0.52
Cancer	158 (7.9)	61 (8.7)	71 (8.1)	27 (6.5)	0.41
Clinical presentation
Systolic blood pressure (mmHg)	139 (120-159)	135 (116-155)ae	140 (120-160)ac	141 (127-162)ce	< 0.001
HEMORR2HAGES score	1 (0-2)	1 (0-2)	1 (0-2)	1 (0-2)	0.09
CRUSADE score	24 (14-37)	29 (18-42)ae	21 (12-33)ac	18 (9-33)ce	< 0.001
Infarct characteristics
Time from symptoms to first medical contact (h)	2.25 (1-5.5)	2.3 (1.2-5.7)	2 (1-4)c	2 (1-6)c	0.024
Time from symptoms to admission (h)	3 (1.9-6.5)	3.1 (2-6.3)	2 (1-6)c	3 (2-7)c	0.025
Anterior infarction	820 (41)	294 (41.6)	362 (41.3)	166 (40.2)	0.57
Multivessel disease	1003 (53)	356 (53.2)	433 (52.5)	217 (54.5)	0.75
Femoral access	1017 (57.5)	365 (59.5)e	463 (58.7)c	191 (51.5)ce	0.021
Duration of the angioplasty procedure (min)	39 (22-60)	40 (22-59)	38 (22-60)	40 (21-60)	0.8
Fibrinolysis	307 (15.4)	100 (14.1)	153 (17.4)	55 (13.3)	0.06
Final TIMI 3 flow	1508 (92.8)	527 (92.5)	670 (93.3)	314 (92.4)	0.7
LVEF (%)	50 (40-55)	47 (36-58)	49 (38-59)	48 (38-59)	0.09
Creatine phosphokinase peak (UI/L)	1404 (606-2675)	1374 (520-2565)e	1367 (626-2711)	1526 (728-2683)e	0.048
Prior medication
Antivitamin K	62 (3.1)	21 (3)	29 (3.3)	12 (2.9)	0.91
In-hospital medication
Aspirin	1964 (98.3)	696 (98.9)	863 (98.6)	408 (98.8)	0.95
Clopidogrel	1777 (88.9)	627 (89.1)	786 (89.9)	367 (88.9)	0.74
Prasugrel	223 (11.2)	75 (11.5)	95 (11.4)	53 (13.6)	0.48
Antivitamin K	35 (1.8)	13 (1.9)	12 (1.4)	10 (2.4)	0.4
LMWH	1481 (74.1)	511 (72.7)	671 (76.7)	302 (73.3)	0.06
UFH	454 (22.7)	166 (23.6)	180 (20.6)	108 (26.2)	0.06
LMWH + UFH	198 (9.9)	71 (10.1)	78 (8.9)	49 (11.9)	0.25
Bivalirudin (since 2010, for information)	136	55	55	26	0.41

Data given as number (%) or median (interquartile range).

^aP < 0.05 to compare body mass index (BMI) < 25 kg/m² with BMI between 25 kg/m² and 30 kg/m²;

^cP < 0.05 to compare BMI between 25 kg/m² and 30 kg/m² with BMI ≥ 30 kg/m²;

^eP < 0.05 to compare BMI < 25 kg/m² with BMI ≥ 30 kg/m². BMI: Body mass index; LEVF: Left ventricular ejection fraction; LMWH: Low molecular weight heparin; TIMI: Thrombolysis in Myocardial Infarction; UFH: Unfractionated heparin.

Table 2 In-hospital and one-year events

	Total	BMI < 25 kg/m²	25 ≤ BMI < 30 kg/m²	BMI ≥ 30 kg/m²	P value
	n = 1998	n = 705	n = 877	n = 416
In-hospital events
Duration of hospitalisation in intensive care (d)	5 (3-7)	5 (4-7)	5 (3-7)	5 (3-6)	0.21
Heart failure	417 (20.9)	153 (21.7)	176 (20.1)	89 (21.5)	0.56
Stent thrombosis	38 (1.9)	19 (2.5)	11 (1.3)	8 (1.9)	0.16
Atrial fibrillation	196 (9.8)	75 (10.6)	92 (10.5)	29 (7.0)	0.06
Stroke	39 (2.0)	14 (2)	19 (2.2)	6 (1.4)	0.65
Tamponade	22 (1.1)	10 (1.4)	7 (0.8)	5 (1.2)	0.56
Mortality	115 (5.8)	54 (7.6)ae	43 (4.9)a	18 (4.3)e	0.018
Cardiovascular mortality	112 (5.6)	54 (7.6)ae	40 (4.6)a	18 (4.3)e	0.013
In-hospital bleeding events
Input Haemoglobin (g/dL)	14.4 (13.3-15.5)	14.1 (13-15.3)ae	14.6 (13.5-15.6)a	14.7 (13.5-15.7)e	< 0.001
Haemoglobin drop (g/dL)	1.9 (0.9-2.9)	2 (1-3.2)ae	1.7 (0.8-2.9)a	1.8 (0.9-2.7)e	0.016
Input haematocrit (%)	42.6 (39.6-45.5)	42 (38.9-44.9)ae	42.8 (40-45.8)a	43.3 (40.2-45.6)e	< 0.001
Haematocrit drop (%)	5.3 (2.8-8.4)	6.1 (3.1-9.3)ae	5 (2.6-8.1)a	4.9 (2.8-7.8)e	< 0.001
Haemorrhagic stroke	9 (0.5)	6 (0.8)	3 (0.3)	0 (0.0)	0.07
Gastrointestinal bleeding	25 (1.3)	12 (1.7)	8 (0.9)	5 (1.2)	0.45
Haematoma at the puncture site	138 (6.9)	56 (7.9)	58 (6.6)	24 (5.8)	0.22
Surgical repair of the haematoma	9 (0.5)	3 (0.4)	4 (0.5)	2 (0.5)	0.98
Use of amines in bleeding	33 (1.7)	18 (2.5)	10 (1.1)	6 (1.4)	0.13
Transfusion	82 (4.1)	42 (5.9)a	25 (2.9)a	15 (3.6)	0.011
Fatal bleeding (BARC 5)	9 (0.5)	6 (0.8)	2 (0.2)	1 (0.2)	0.17
BARC 3 or 5	146 (7.3)	67 (9.5)ae	54 (6.2)a	26 (6.2)e	0.031
One-year events
Mortality	198 (9.9)	93 (13.1)ae	82 (9.4)ac	23 (5.5)ce	< 0.001
CV mortality	160 (8.0)	76 (10.8)ae	62 (7.1)a	22 (5.3)e	0.001

^aP < 0.05 to compare body mass index (BMI) < 25 kg/m² with BMI between 25 kg/m² and 30 kg/m²;

^cP < 0.05 to compare BMI between 25 kg/m² and 30 kg/m² with BMI ≥ 30 kg/m²;

^eP < 0.05 to compare BMI < 25 kg/m² with BMI ≥ 30 kg/m². BARC: Bleeding Academic Research Consortium; BMI: Body mass index; CV: Cardiovascular.

Table 3 Predictor of Bleeding Academic Research Consortium 3 and 5 bleeding by univariate and multivariate analysis

	Univariate analysis	Multivariate analysis	Odds ratio (95%CI)
	P value	P value
Male	0.001	0.19
Age (per decade)	< 0.001	0.08
Hypertension	0.001	0.18
BMI < 25 kg/m²	0.006	0.75
Smoker	0.005	0.31
Renal failure	0.032	0.77
Radial puncture access	0.001	0.036	0.54 (0.3-0.96)
Duration of the procedure	< 0.001	0.004	1 (1-1.01)
Multivessel disease	0.003	0.76
Final TIMI flow	0.005	0.46
Creatine phosphokinase peak (per 500 UI/L)	< 0.001	0.15
Left ventricular ejection fraction	< 0.001	0.017	0.97 (0.94-0.99)
Antivitamin K use before	0.016	0.48

BMI: Body mass index; TIMI: Thrombolysis in myocardial infarction.

Table 4 Predictor of one-year cardiovascular mortality by univariate and multivariate analysis

	Univariate analysis	Multivariate analysis	Hazard ratio (95%CI)
	P value	P value
Male	< 0.001	0.5
Age (per decade)	< 0.001	< 0.001	1.56 (1.31-1.87)
Hypertension	< 0.001	0.28
BMI < 25 kg/m²	< 0.001	0.5
Smoker	< 0.001	0.62
Diabetes mellitus	0.042	0.71
Prior myocardial infarction	0.011	0.015	1.91 (1.13-3.22)
Stroke history	< 0.001	0.011	2.07 (1.17-3.64)
Renal failure	< 0.001	0.43
Cancer	0.002	0.02	1.83 (1.09-3.06)
Radial puncture access	< 0.001	0.06
Creatine phosphokinase peak (per 500 UI/L)	0.003	< 0.001	1.05 (1.03-1.07)
In-hospital heart failure	< 0.001	< 0.001	5.29 (3.44-8.13)
BARC 3 among BMI < 25 kg/m²	< 0.001	< 0.001	2.97 (1.61-5.5)
BARC 3 among BMI ≥ 25 kg/m²	< 0.001	0.041	1.94 (1.02-3.69)

BARC: Bleeding Academic Research Consortium; BMI: Body mass index; TIMI: Thrombolysis in myocardial infarction.