title: Body mass index and effectiveness of reperfusion strategies: implications for the management of patients with ST-elevation myocardial infarction.
abstract: 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.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina 27715, USA. mehta007@dcri.duke.edu
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiele
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: 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
chemical_list: D000933:Antifibrinolytic Agents