title: Lack of "obesity paradox" in patients presenting with ST-segment elevation myocardial infarction including cardiogenic shock: a multicenter German network registry analysis.
abstract: BACKGROUND
  Studies have associated obesity with better outcomes in comparison to non-obese patients after elective and emergency coronary revascularization. However, these findings might have been influenced by patient selection. Therefore we thought to look into the obesity paradox in a consecutive network STEMI population.
  
  
  METHODS
  The database of two German myocardial infarction network registries were combined and data from a total of 890 consecutive patients admitted and treated for acute STEMI including cardiogenic shock and cardiopulmonary resuscitation according to standardized protocols were analyzed. Patients were categorized in normal weight (≤24.9 kg/m(2)), overweight (25-30 kg/m(2)) and obese (>30 kg/m(2)) according to BMI.
  
  
  RESULTS
  Baseline clinical parameters revealed a higher comorbidity index for overweight and obese patients; 1-year follow-up comparison between varying groups revealed similar rates of all-cause death (9.1 % vs. 8.3 % vs. 6.2 %; p = 0.50), major adverse cardiac and cerebrovascular [MACCE (15.1 % vs. 13.4 % vs. 10.2 %; p = 0.53)] and target vessel revascularization in survivors [TVR (7.0 % vs. 5.0 % vs. 4.0 %; p = 0.47)] with normal weight when compared to overweight or obese patients. These results persisted after risk-adjustment for heterogeneous baseline characteristics of groups. An analysis of patients suffering from cardiogenic shock showed no impact of BMI on clinical endpoints.
  
  
  CONCLUSIONS
  Our data from two network systems in Germany revealed no evidence of an "obesity paradox"in an all-comer STEMI population including patients with cardiogenic shock.
authors.affiliation: Universitätsmedizin Mannheim, Mannheim, Germany. Ibrahim.akin@med.uni-rostock.de.|Medical Faculty Mannheim, University Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany. Ibrahim.akin@med.uni-rostock.de.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.affiliation: Universitätsklinikum Rostock und Hanseklinikum Wismar, .Rostock, .Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Schneider
authors.affiliation: Universitätsklinikum Rostock, .Rostock, .Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Schwarzwald-Baar Klinikum Villingen-Schwenningen, .Villingen-Schwenningen, .Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
authors.affiliation: Schwarzwald-Baar Klinikum Villingen-Schwenningen, .Villingen-Schwenningen, .Germany.
authors.forename: Mike
authors.initials: M
authors.lastname: Lübke
authors.affiliation: Asklepios Klinikum St. Georg Hamburg, .Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: Universitätsmedizin Mannheim, Mannheim, Germany.
authors.forename: Uzair
authors.initials: U
authors.lastname: Ansari
authors.affiliation: Universitätsklinikum Rostock und Kardiovaskuläres Zentrum Darmstadt, Darmstadt, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Wunderlich
authors.affiliation: Universitätsklinikum Rostock und Herzklinik Ulm, Ulm, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D020521:Stroke / Q000453:epidemiology*