Obesity and outcomes in cardiogenic shock due to acute myocardial infarction

Abstract Background Obesity paradox in heart failure (HF) is defined as better outcomes associated with higher body mass index (BMI). Purpose We explored the relationship between BMI and outcomes in cardiogenic shock (CS) due to acute myocardial infarction. Methods The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. In- hospital mortality, as a main outcome measure, was analyzed depending on BMI as a continuous variable, as well as BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2) for the subset of CS due to acute myocardial infarction (AMI-CS). We also explored mortality in categorized BMI subsets (underweight, normal weight, overweight, obese, and morbidly obese). Results A total of 969 patients with AMI-CS were included. The in-hospital mortality was 42.4%. When analyzed as a continuous variable, BMI had no association with survival to discharge. When the cohort was divided into quartiles according to BMI, mortality was consistent with 42.2%, 38.5%, 39.5%, and 49.3%, respectively, p=0.082. In categorized subsets, mortality was 30% in the underweight, 42.9% in the normal weight, 37.4% in the overweight, 44.5.% in the obese, and 47.9% in morbidly obese, p=0.15. Conclusions In acute myocardial infarction-related cardiogenic shock, obesity creates no survival advantage.