title: Association of Obesity With In-Hospital Mortality of Cardiogenic Shock Complicating Acute Myocardial Infarction.
abstract: Several previous studies have shown obesity to be counterintuitively associated with more favorable mortality in patients with acute myocardial infarction (AMI); however, the association of obesity with in-hospital mortality of cardiogenic shock complicating AMI has not been previously examined. We queried the 2004 to 2013 National Inpatient Sample databases to identify all patients ≥18 years hospitalized with the principal diagnosis of AMI. Multivariable regression models adjusting for demographics, hospital characteristics, and co-morbidities were used to examine differences in incidence and in-hospital mortality of cardiogenic shock complicating AMI between obese and nonobese patients. Of 6,097,817 patients with AMI, 290,894 (4.8%) had cardiogenic shock. There was no difference in risk-adjusted incidence of cardiogenic shock between obese and nonobese patients (adjusted odds ratio 1.00, 95% CI 0.98 to 1.01; p = 0.46). Of the patients with cardiogenic shock complicating AMI, 8.9% had a documented diagnosis of obesity. Obese patients were on average 6 years younger and had higher prevalence of most cardiovascular co-morbidities. Obese patients were more likely to receive revascularization (73.0% vs 63.4%, p <0.001) and had lower risk-adjusted in-hospital mortality compared with nonobese patients (28.2% vs 36.5%; adjusted odds ratio 0.89, 95% CI 0.86 to 0.92; p <0.001). Similar findings were seen in subgroups of patients with cardiogenic shock complicating ST elevation or non-ST elevation MI. In conclusion, this large retrospective analysis of a nationwide cohort of patients with cardiogenic shock complicating AMI demonstrated that obese patients were younger, more likely to receive revascularization, and had modestly lower risk-adjusted in-hospital mortality compared with nonobese patients.
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Kshitij
authors.initials: K
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: tgupta@montefiore.org.
authors.forename: Tanush
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Pennsylvania.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Anusha
authors.initials: A
authors.lastname: Shanbhag
authors.affiliation: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Kavisha
authors.initials: K
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Pedro
authors.initials: P
authors.lastname: Villablanca
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Nayan
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Menegus
authors.affiliation: Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Nikhil K
authors.initials: NK
authors.lastname: Meena
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology