title: Elevated body mass index and intermediate-term clinical outcomes after acute coronary syndromes.
abstract: OBJECTIVE
  Obesity is a coronary disease risk factor, but its independent effect on clinical outcomes following acute coronary syndromes has not been quantified. We evaluated the relationship between elevated body mass index (BMI) and 30-day, 90-day, and 1-year clinical outcomes postacute coronary syndromes.
  
  
  METHODS
  Using 15 071 patients (normal weight [BMI = 18.5-24.9 kg/m(2)], overweight [BMI = 25-29.9 kg/m(2)], obese [BMI = 30-34.9 kg/m(2)] or very obese [BMI > or =35 kg/m(2)]) randomized from 1997-1999 in the SYMPHONY (Sibrafiban vs aspirin to Yield Maximum Protection from ischemic Heart events postacute cOroNary sYndromes) and 2nd SYMPHONY trials, we evaluated the relationships between BMI and 30-day, 90-day, and 1-year mortality and 30-day and 90-day death or myocardial infarction.
  
  
  RESULTS
  Increasing BMI was associated with younger age, multiple comorbidities, and greater cardiac medication and procedure use; however, systolic function and coronary disease extent were similar for all BMI categories. Unadjusted Kaplan-Meier mortality estimates were higher for normal-weight patients than for all other BMI groups. After multivariable adjustment, the 30-day mortality hazard ratios (95% confidence interval [CI]) were: overweight, 0.66 (95% CI: 0.47 to 0.94); obese, 0.61 (95% CI: 0.39 to 0.97); very obese, 0.89 (95% CI: 0.48 to 1.64). Adjusted hazard ratios were similar for 90-day and 1-year mortality. There were no statistically significant differences among BMI groups in 30-day and 90-day death or myocardial infarction (unadjusted or adjusted).
  
  
  CONCLUSIONS
  Overweight and obese BMI classifications were associated with better intermediate-term survival after acute coronary syndromes than normal weight and very obese, but death or myocardial infarction rates were similar. Further study is required to understand the apparent association of overweight and moderate obesity with better intermediate-term outcomes.
authors.affiliation: Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC 27715, USA. eisen006@mc.duke.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Manjushri V
authors.initials: MV
authors.lastname: Bhapkar
authors.forename: Arni
authors.initials: A
authors.lastname: Kristinsson
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015992:Body Mass Index; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D009765:Obesity / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome