Body mass index and effectiveness of reperfusion strategies: implications for the management of patients with ST-elevation myocardial infarction.
BACKGROUND
Fibrinolytic therapy has maximum dose limit in patients with ST-elevation myocardial infarction (STEMI). Consequently, obese patients receive lower dose of fibrinolytic per kg body weight compared to lower weight patients. Whether the relatively lower dose results in lower effectiveness of fibrinolytic agents versus primary percutaneous coronary interventions (PCI) in patients with higher body mass index (BMI) is not known.


METHODS
We analyzed 7,630 STEMI patients receiving primary PCI (46%) or fibrinolysis (54%) < 24 hours of symptom onset from the MITRA PLUS registry. The relative effectiveness of the 2 reperfusion strategies on in-hospital death (adjusted with propensity scores) and bleeding were studied in 3 BMI groups: I-BMI 20-24.9 kg/m(2) (n = 2,277), II-BMI 25-29.9 kg/m(2) (n = 3,763), and III-BMI > or = 30 kg/m(2) (n = 1,590).


RESULTS
BMI was inversely related to death, shock, stroke, and bleeding in patients treated with either reperfusion strategy. However, compared with primary PCI, fibrinolysis was associated with higher adjusted death with similar relative adjusted difference in all 3 groups (group I OR 1.69, 95% CI 1.19-2.44; group II OR 1.89, 95% CI 1.39-2.56; group III OR 1.85, 95% CI 1.08-3.22).


CONCLUSIONS
Compared with primary PCI, fibrinolysis was associated with relatively similar higher risk of death in all 3 BMI groups. Whether the differences in death between fibrinolysis and primary PCI in the high-BMI categories can be reduced by higher fibrinolytic doses without increasing bleeding risks needs evaluation in future studies.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Durham, North Carolina 27715, USA. mehta007@dcri.duke.edu
Gitt
Anselm K
AK
Jünger
Claus
C
Zeymer
Uwe
U
Schiele
Rudolf
R
Zahn
Ralf
R
Senges
Jochen
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents