title: Association of body mass index and long-term outcomes in older patients with non-ST-segment-elevation myocardial infarction: results from the CRUSADE Registry.
abstract: BACKGROUND
  Prior studies have found that obese patients have paradoxically lower in-hospital mortality after non-ST-segment-elevation myocardial infarction than their normal-weight counterparts, yet whether these associations persist long term is unknown.
  
  
  RESULTS
  We linked detailed clinical data for patients with non-ST-segment-elevation myocardial infarction aged ≥65 years in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Registry to Medicare claims data to obtain longitudinal outcomes. Using height and weight measured on admission, patients were categorized into 6 body mass index (BMI [kilograms per meter squared]) groups. Multivariable Cox proportional hazards models were used to estimate the association between BMI and (1) all-cause mortality, (2) all-cause readmission, (3) cardiovascular readmission, and (4) noncardiovascular readmission for 3 years after hospital discharge. Among older patients with non-ST-segment-elevation myocardial infarction (n=34,465), 36.3% were overweight and 27.7% were obese. Obese patients were younger and more likely to have hypertension, diabetes mellitus, and dyslipidemia than normal or underweight patients. Relative to normal-weight patients, long-term mortality was lower for patients classified as overweight (BMI, 25.0-29.9), obese class I (BMI, 30.0-34.9), and obese class II (BMI, 35.0-39.9), but not obese class III (BMI ≥40.0). In contrast, 3-year all-cause and cardiovascular readmission were similar across BMI categories. Relative to normal-weight patients, noncardiovascular readmissions were similar for obese class I but higher for obese class II and obese class III.
  
  
  CONCLUSIONS
  All-cause long-term mortality was generally lower for overweight and obese older patients after non-ST-segment-elevation myocardial infarction relative to those with normal weight. Longitudinal readmissions were similar or higher with increasing BMI.
authors: Departments of Clinical Pharmacology and Outcomes Research Duke Clinical Research Institute, Durham, NC; and Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
authors: Emily C
authors: EC
authors: O'Brien
authors: Emil L
authors: EL
authors: Fosbol
authors: S Andrew
authors: SA
authors: Peng
authors: Karen P
authors: KP
authors: Alexander
authors: Matthew T
authors: MT
authors: Roe
authors: Eric D
authors: ED
authors: Peterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: acute coronary syndrome; obesity