J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 11, November 2022, pages 458-465

Relationship Between Body Mass Index and Outcomes in Acute Myocardial Infarction

Figure 1. Differences in patient characteristics, resource utilization and in-hospital outcomes among those admitted for acute myocardial infarction based on body mass index [12].

**Table 1.** Patient and Hospital Characteristics by Body Mass Index
Characteristics	Overall (n = 561,520^a)	Body mass index	P-value^b
^aMean (SD); n (%). ^b Wilcoxon rank-sum test for complex survey samples; Chi-squared test with Rao and Scott’s second-order correction. SD: standard deviation.
Age	63 (SD 13)	75 (SD 12)	74 (SD 12)	67 (SD 13)	63(SD 12)	60 (SD 12)	< 0.001
Gender	233,115 (42%)	20,365 (59%)	9,240 (45%)	18,495 (36%)	105,770 (36%)	79,245 (49%)	< 0.001
Race							< 0.001
White	397,085 (73%)	24,660 (73%)	13,630 (69%)	34,805 (69%)	211,250 (74%)	112,740 (73%)
Black	71,005 (13%)	4,760 (14%)	2,640 (13%)	5,680 (11%)	32,815 (12%)	25,110 (16%)
Hispanic	47,795 (8.8%)	2,035 (6.0%)	2,080 (10%)	6,110 (12%)	26,475 (9.3%)	11,095 (7.2%)
Asian or Pacific Islander	9,530 (1.8%)	1,385 (4.1%)	840 (4.2%)	1,515 (3.0%)	4,425 (1.6%)	1,365 (0.9%)
Native American	3,595 (0.7%)	235 (0.7%)	90 (0.5%)	290 (0.6%)	1,885 (0.7%)	1,095 (0.7%)
Other	14,020 (2.6%)	810 (2.4%)	615 (3.1%)	1,760 (3.5%)	7,340 (2.6%)	3,495 (2.3%)
Insurance							< 0.001
Medicare	284,825 (51%)	27,710 (80%)	1 5,235 (74%)	28,950 (56%)	137,940 (47%)	74,990 (47%)
Medicaid	62,325 (11%)	2,635 (7.6%)	1,795 (8.8%)	5,125 (9.9%)	30,550 (10%)	22,220 (14%)
Private insurance	167,735 (30%)	3,055 (8.8%)	2,355 (12%)	13,505 (26%)	99,550 (34%)	49,270 (31%)
Self-pay	27,230 (4.9%)	585 (1.7%)	570 (2.8%)	2,390 (4.6%)	15,255 (5.2%)	8,430 (5.3%)
No charge	2,630 (0.5%)	60 (0.2%)	60 (0.3%)	275 (0.5%)	1,540 (0.5%)	695 (0.4%)
Other	16,010 (2.9%)	620 (1.8%)	450 (2.2%)	1,365 (2.6%)	9,135 (3.1%)	4,440 (2.8%)
Hospital bed size							< 0.001
Small	99,380 (18%)	6,695 (19%)	3,865 (19%)	8,660 (17%)	50,820 (17%)	29,340 (18%)
Medium	166,950 (30%)	10,470 (30%)	6,165 (30%)	15,500 (30%)	87,910 (30%)	46,905 (29%)
Large	295,190 (53%)	17,540 (51%)	10,445 (51%)	27,530 (53%)	155,635 (53%)	84,040 (52%)
Total charges	105,172 (121,538)	89,245 (117,306)	110,480 (147,366)	116,281 (132,570)	105,114 (110,906)	104,445 (132,798)	< 0.001
Hospital region							< 0.001
Northeast	89,830 (16%)	6,510 (19%)	3,390 (17%)	7,785 (15%)	45,955 (16%)	26,190 (16%)
Midwest	146,100 (26%)	8,380 (24%)	5,130 (25%)	11,270 (22%)	77,825 (26%)	43,495 (27%)
South	224,075 (40%)	13,300 (38%)	7,765 (38%)	21,635 (42%)	115,915 (39%)	65,460 (41%)
West	101,515 (18%)	6,515 (19%)	4,190 (20%)	11,000 (21%)	54, 670 (19%)	25,140 (16%)
Median household income							< 0.001
0-25th	173,455 (31%)	11,685 (34%)	6,520 (32%)	15,495 (31%)	86,490 (30%)	53,265 (34%)
26th-50th	154,445 (28%)	9,010 (27%)	5,445 (27%)	13,520 (27%)	80,715 (28%)	45,755 (29%)
51st-75th	131,890 (24%)	7,370 (22%)	4,670 (23%)	12,205 (24%)	70, 685 (24%)	36,960 (23%)
75th-100th	91,930 (17%)	5,925 (17%)	3,495 (17%)	9,455 (19%)	51,330 (18%)	21,725 (14%)

Table 1. Patient and Hospital Characteristics by Body Mass Index

Characteristics

Overall (n = 561,520^a)

Body mass index

P-value^b

< 20 (n = 34,705^a)

20 - 24 (n = 20,475^a)

25 - 29 (n = 51,690^a)

30 - 39 (n = 294,365^a)

> 40 (n = 160,285^a)

^aMean (SD); n (%). ^b Wilcoxon rank-sum test for complex survey samples; Chi-squared test with Rao and Scott’s second-order correction. SD: standard deviation.

Age

63 (SD 13)

75 (SD 12)

74 (SD 12)

67 (SD 13)

63(SD 12)

60 (SD 12)

< 0.001

Gender

233,115 (42%)

20,365 (59%)

9,240 (45%)

18,495 (36%)

105,770 (36%)

79,245 (49%)

< 0.001

Race

< 0.001

White

397,085 (73%)

24,660 (73%)

13,630 (69%)

34,805 (69%)

211,250 (74%)

112,740 (73%)

Black

71,005 (13%)

4,760 (14%)

2,640 (13%)

5,680 (11%)

32,815 (12%)

25,110 (16%)

Hispanic

47,795 (8.8%)

2,035 (6.0%)

2,080 (10%)

6,110 (12%)

26,475 (9.3%)

11,095 (7.2%)

Asian or Pacific Islander

9,530 (1.8%)

1,385 (4.1%)

840 (4.2%)

1,515 (3.0%)

4,425 (1.6%)

1,365 (0.9%)

Native American

3,595 (0.7%)

235 (0.7%)

90 (0.5%)

290 (0.6%)

1,885 (0.7%)

1,095 (0.7%)

Other

14,020 (2.6%)

810 (2.4%)

615 (3.1%)

1,760 (3.5%)

7,340 (2.6%)

3,495 (2.3%)

Insurance

< 0.001

Medicare

284,825 (51%)

27,710 (80%)

1 5,235 (74%)

28,950 (56%)

137,940 (47%)

74,990 (47%)

Medicaid

62,325 (11%)

2,635 (7.6%)

1,795 (8.8%)

5,125 (9.9%)

30,550 (10%)

22,220 (14%)

Private insurance

167,735 (30%)

3,055 (8.8%)

2,355 (12%)

13,505 (26%)

99,550 (34%)

49,270 (31%)

Self-pay

27,230 (4.9%)

585 (1.7%)

570 (2.8%)

2,390 (4.6%)

15,255 (5.2%)

8,430 (5.3%)

No charge

2,630 (0.5%)

60 (0.2%)

60 (0.3%)

275 (0.5%)

1,540 (0.5%)

695 (0.4%)

Other

16,010 (2.9%)

620 (1.8%)

450 (2.2%)

1,365 (2.6%)

9,135 (3.1%)

4,440 (2.8%)

Hospital bed size

< 0.001

Small

99,380 (18%)

6,695 (19%)

3,865 (19%)

8,660 (17%)

50,820 (17%)

29,340 (18%)

Medium

166,950 (30%)

10,470 (30%)

6,165 (30%)

15,500 (30%)

87,910 (30%)

46,905 (29%)

Large

295,190 (53%)

17,540 (51%)

10,445 (51%)

27,530 (53%)

155,635 (53%)

84,040 (52%)

Total charges

105,172 (121,538)

89,245 (117,306)

110,480 (147,366)

116,281 (132,570)

105,114 (110,906)

104,445 (132,798)

< 0.001

Hospital region

< 0.001

Northeast

89,830 (16%)

6,510 (19%)

3,390 (17%)

7,785 (15%)

45,955 (16%)

26,190 (16%)

Midwest

146,100 (26%)

8,380 (24%)

5,130 (25%)

11,270 (22%)

77,825 (26%)

43,495 (27%)

South

224,075 (40%)

13,300 (38%)

7,765 (38%)

21,635 (42%)

115,915 (39%)

65,460 (41%)

West

101,515 (18%)

6,515 (19%)

4,190 (20%)

11,000 (21%)

54, 670 (19%)

25,140 (16%)

Median household income

< 0.001

0-25th

173,455 (31%)

11,685 (34%)

6,520 (32%)

15,495 (31%)

86,490 (30%)

53,265 (34%)

26th-50th

154,445 (28%)

9,010 (27%)

5,445 (27%)

13,520 (27%)

80,715 (28%)

45,755 (29%)

51st-75th

131,890 (24%)

7,370 (22%)

4,670 (23%)

12,205 (24%)

70, 685 (24%)

36,960 (23%)

75th-100th

91,930 (17%)

5,925 (17%)

3,495 (17%)

9,455 (19%)

51,330 (18%)

21,725 (14%)

**Table 2.** Patient Baseline Comorbidities by Body Mass Index
Characteristics	Overall (n = 561,520^a)	Body mass index	P-value^b
^an (%). ^bChi-squared test with Rao and Scott’s second-order correction. SD: standard deviation.
Hypertension	486,270 (87%)	25,995 (75%)	16,620 (81%)	43,735 (85%)	257,195 (87%)	142,725 (89%)	< 0.001
Diabetes mellitus	296,520 (53%)	7,305 (21%)	7,230 (35%)	24,855 (48%)	158,845 (54%)	98,285 (61%)	< 0.001
Chronic kidney disease	143,585 (26%)	9,750 (28%)	6,815 (33%)	13,320 (26%)	68,720 (23%)	44,980 (28%)	< 0.001
Heart failure	214,075 (38%)	17,205 (50%)	10,320 (50%)	18,985 (37%)	98,010 (33%)	69,555 (43%)	< 0.001
Stroke	5,730 (1.0%)	565 (1.6%)	360 (1.8%)	650 (1.3%)	2,615 (0.9%)	1,540 (1.0%)	< 0.001
Transient ischemic attack	1,570 (0.3%)	165 (0.5%)	100 (0.5%)	105 (0.2%)	745 (0.3%)	455 (0.3%)	< 0.001
Atrial fibrillation	115,670 (21%)	10,180 (29%)	6,175 (30%)	10,530 (20%)	55,015 (19%)	33,770 (21%)	< 0.001
Charleston comorbidity index	3.2 (SD 4.6)	3.9 (SD 4.8)	4.0 (SD 5.1)	3.2 (SD 4.6)	3.0 (SD 4.2)	3.4 (SD 5.1)	< 0.001

Table 2. Patient Baseline Comorbidities by Body Mass Index

Characteristics

Overall (n = 561,520^a)

Body mass index

P-value^b

< 20 (n = 34,705^a)

20 - 24 (n = 20,475^a)

25 - 29 (n = 51,690^a)

30 - 40 (n = 294,365^a)

> 40 (n = 160,285^a)

^an (%). ^bChi-squared test with Rao and Scott’s second-order correction. SD: standard deviation.

Hypertension

486,270 (87%)

25,995 (75%)

16,620 (81%)

43,735 (85%)

257,195 (87%)

142,725 (89%)

< 0.001

Diabetes mellitus

296,520 (53%)

7,305 (21%)

7,230 (35%)

24,855 (48%)

158,845 (54%)

98,285 (61%)

< 0.001

Chronic kidney disease

143,585 (26%)

9,750 (28%)

6,815 (33%)

13,320 (26%)

68,720 (23%)

44,980 (28%)

< 0.001

Heart failure

214,075 (38%)

17,205 (50%)

10,320 (50%)

18,985 (37%)

98,010 (33%)

69,555 (43%)

< 0.001

Stroke

5,730 (1.0%)

565 (1.6%)

360 (1.8%)

650 (1.3%)

2,615 (0.9%)

1,540 (1.0%)

< 0.001

Transient ischemic attack

1,570 (0.3%)

165 (0.5%)

100 (0.5%)

105 (0.2%)

745 (0.3%)

455 (0.3%)

< 0.001

Atrial fibrillation

115,670 (21%)

10,180 (29%)

6,175 (30%)

10,530 (20%)

55,015 (19%)

33,770 (21%)

< 0.001

Charleston comorbidity index

3.2 (SD 4.6)

3.9 (SD 4.8)

4.0 (SD 5.1)

3.2 (SD 4.6)

3.0 (SD 4.2)

3.4 (SD 5.1)

< 0.001

**Table 3.** Distribution of Clinical Course and Utilization of Revascularization Procedures by Body Mass Index
Characteristics	Overall (n = 561,520^a)	Body mass index	P-value^b
^an (%). ^bChi-squared test with Rao and Scott’s second-order correction. STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft.
STEMI	119,885 (21%)	5,240 (15%)	3,300 (16%)	12,680 (25%)	68,935 (23%)	29,730 (19%)	< 0.001
NSTEMI	397,565 (71%)	24,660 (71%)	14,435 (71%)	35,165 (68%)	206,515 (70%)	116,790 (73%)	< 0.001
Other MI (not MI/NSTEMI)	17,340 (3.1%)	2,215 (6.4%)	1,330 (6.5%)	1,590 (3.1%)	6,845 (2.3%)	5,360 (3.3%)	< 0.001
Ventricular tachycardia	37,030 (6.6%)	2,315 (6.7%)	1,265 (6.2%)	3,650 (7.1%)	19,060 (6.5%)	10,740 (6.7%)	0.14
Ventricular fibrillation	16,735 (3.0%)	765 (2.2%)	540 (2.6%)	1,785 (3.5%)	8,355 (2.8%)	5,290 (3.3%)	< 0.001
PCI	258,650 (46%)	7,380 (21%)	5,635 (28%)	23,935 (46%)	149,550 (51%)	72,150 (45%)	< 0.001
CABG	72,465 (13%)	1,530 (4.4%)	1,725 (8.4%)	7,780 (15%)	44,935 (15%)	16,495 (10%)	< 0.001
Systemic thrombolysis	10,085 (1.8%)	1,350 (3.9%)	640 (3.1%)	675 (1.3%)	3,665 (1.2%)	3,755 (2.3%)	< 0.001

Table 3. Distribution of Clinical Course and Utilization of Revascularization Procedures by Body Mass Index

Characteristics

Overall (n = 561,520^a)

Body mass index

P-value^b

< 20 (n = 34,705^a)

20 - 24 (n = 20,475^a)

25 - 29 (n = 51,690^a)

30 - 40 (n = 294,365^a)

> 40 (n = 160,285^a)

^an (%). ^bChi-squared test with Rao and Scott’s second-order correction. STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft.

STEMI

119,885 (21%)

5,240 (15%)

3,300 (16%)

12,680 (25%)

68,935 (23%)

29,730 (19%)

< 0.001

NSTEMI

397,565 (71%)

24,660 (71%)

14,435 (71%)

35,165 (68%)

206,515 (70%)

116,790 (73%)

< 0.001

Other MI (not MI/NSTEMI)

17,340 (3.1%)

2,215 (6.4%)

1,330 (6.5%)

1,590 (3.1%)

6,845 (2.3%)

5,360 (3.3%)

< 0.001

Ventricular tachycardia

37,030 (6.6%)

2,315 (6.7%)

1,265 (6.2%)

3,650 (7.1%)

19,060 (6.5%)

10,740 (6.7%)

0.14

Ventricular fibrillation

16,735 (3.0%)

765 (2.2%)

540 (2.6%)

1,785 (3.5%)

8,355 (2.8%)

5,290 (3.3%)

< 0.001

PCI

258,650 (46%)

7,380 (21%)

5,635 (28%)

23,935 (46%)

149,550 (51%)

72,150 (45%)

< 0.001

CABG

72,465 (13%)

1,530 (4.4%)

1,725 (8.4%)

7,780 (15%)

44,935 (15%)

16,495 (10%)

< 0.001

Systemic thrombolysis

10,085 (1.8%)

1,350 (3.9%)

640 (3.1%)

675 (1.3%)

3,665 (1.2%)

3,755 (2.3%)

< 0.001

**Table 4.** Patient Complications and Resource Utilization by Body Mass Index
Characteristics	Overall (n = 561,520^a)	Body mass index	P- value^b
^aMean (SD); n (%). ^bWilcoxon rank-sum test for complex survey samples; Chi-squared test with Rao and Scott’s second-order correction. GI: gastrointestinal; PRBC: packed red blood cell.
Length of hospital	5.0 (SD 5.7)	6.6 (SD 7.5)	6.7 (SD 7.0)	5.3 (SD 6.2)	4.6 (SD 4.9)	5.2 (SD 6.3)	< 0.001
Total charges	105,172 (SD 121,538)	89,245 (SD 117,306)	110,480 (SD 147,366)	116,281 (SD 132,570)	105,114 (SD 110,906)	104,445 (SD 132,798)	< 0.001
Mechanical ventilation	27,785 (4.9%)	2,495 (7.2%)	1,260 (6.2%)	1,960 (3.8%)	11,615 (3.9%)	10,455 (6.5%)	< 0.001
Upper GI bleeding	8,900 (1.6%)	1,380 (4.0%)	830 (4.1%)	1,015 (2.0%)	3,345 (1.1%)	2,330 (1.5%)	< 0.001
Acute kidney injury	122,995 (22%)	9,675 (28%)	6,345 (31%)	11,940(23%)	55,805 (19%)	39,230 (24%)	< 0.001
PRBC transfusion	20,505 (3.7%)	2,220 (6.4%)	1,585 (7.7%)	2,505 (4.8%)	9,150 (3.1%)	5,045 (3.1%)	< 0.001
Circulatory shock	36,945 (6.6%)	2,940 (8.5%)	1,985 (9.7%)	4,200 (8.1%)	17,360 (5.9%)	10,460 (6.5%)	< 0.001
Mortality	19,910 (3.5%)	3,220 (9.3%)	1,615 (7.9%)	1,890 (3.7%)	7,105 (2.4%)	6,080 (3.8%)	< 0.001

Table 4. Patient Complications and Resource Utilization by Body Mass Index

Characteristics

Overall (n = 561,520^a)

Body mass index

P- value^b

< 20 (n = 34,705^a)

20 - 24 (n = 20,475^a)

25 - 29 (n = 51,690^a)

30 - 40 (n = 294,365^a)

> 40 (n = 160,285^a)

^aMean (SD); n (%). ^bWilcoxon rank-sum test for complex survey samples; Chi-squared test with Rao and Scott’s second-order correction. GI: gastrointestinal; PRBC: packed red blood cell.

Length of hospital

5.0 (SD 5.7)

6.6 (SD 7.5)

6.7 (SD 7.0)

5.3 (SD 6.2)

4.6 (SD 4.9)

5.2 (SD 6.3)

< 0.001

Total charges

105,172 (SD 121,538)

89,245 (SD 117,306)

110,480 (SD 147,366)

116,281 (SD 132,570)

105,114 (SD 110,906)

104,445 (SD 132,798)

< 0.001

Mechanical ventilation

27,785 (4.9%)

2,495 (7.2%)

1,260 (6.2%)

1,960 (3.8%)

11,615 (3.9%)

10,455 (6.5%)

< 0.001

Upper GI bleeding

8,900 (1.6%)

1,380 (4.0%)

830 (4.1%)

1,015 (2.0%)

3,345 (1.1%)

2,330 (1.5%)

< 0.001

Acute kidney injury

122,995 (22%)

9,675 (28%)

6,345 (31%)

11,940(23%)

55,805 (19%)

39,230 (24%)

< 0.001

PRBC transfusion

20,505 (3.7%)

2,220 (6.4%)

1,585 (7.7%)

2,505 (4.8%)

9,150 (3.1%)

5,045 (3.1%)

< 0.001

Circulatory shock

36,945 (6.6%)

2,940 (8.5%)

1,985 (9.7%)

4,200 (8.1%)

17,360 (5.9%)

10,460 (6.5%)

< 0.001

Mortality

19,910 (3.5%)

3,220 (9.3%)

1,615 (7.9%)

1,890 (3.7%)

7,105 (2.4%)

6,080 (3.8%)

< 0.001

**Table 5.** Regression Model for Predictors of Mortality
Characteristics	Univariate	Multivariate
BMI: body mass index; OR: odds ratio; CI: confidence interval.
BMI groups
< 20	Ref	Ref	Ref	Ref
20 - 24	0.87 (0.75 - 1.00)	0.057	0.84 (0.73 - 0.96)	0.013
25 - 29	0.56 (0.48 - 0.64)	< 0.001	0.37 (0.33 - 0.42)	< 0.001
30 - 40	0.44 (0.39 - 0.49)	< 0.001	0.24 (0.22 - 0.27)	< 0.001
> 40	0.73 (0.65 - 0.82)	< 0.001	0.39 (0.35 - 0.43)	< 0.001
Age	1.03 (1.03 - 1.04)	< 0.001	1.05 (1.04 - 1.05)	< 0.001
Gender (female)	0.88 (0.82 - 0.94)	< 0.001	1.13 (1.06 - 1.21)	< 0.001
Atrial fibrillation	1.26 (1.17 - 1.36)	< 0.001	1.93 (1.80 - 2.06)	< 0.001
Heart failure	2.03 (1.89 - 2.18)	< 0.001	2.55 (2.38 - 2.72)	< 0.001
Hypertension	0.51 (0.47 - 0.55)	< 0.001	0.59 (0.54 - 0.64)	< 0.001
Diabetes mellitus	1.00 (0.93 - 1.08)	> 0.9	0.90 (0.85 - 0.96)	0.002

Table 5. Regression Model for Predictors of Mortality

Characteristics

Univariate

Multivariate

OR (95% CI)

P-value

OR (95% CI)

P-value

BMI: body mass index; OR: odds ratio; CI: confidence interval.

BMI groups

< 20

Ref

20 - 24

0.87 (0.75 - 1.00)

0.057

0.84 (0.73 - 0.96)

0.013

25 - 29

0.56 (0.48 - 0.64)

< 0.001

0.37 (0.33 - 0.42)

< 0.001

30 - 40

0.44 (0.39 - 0.49)

< 0.001

0.24 (0.22 - 0.27)

< 0.001

> 40

0.73 (0.65 - 0.82)

< 0.001

0.39 (0.35 - 0.43)

< 0.001

Age

1.03 (1.03 - 1.04)

< 0.001

1.05 (1.04 - 1.05)

< 0.001

Gender (female)

0.88 (0.82 - 0.94)

< 0.001

1.13 (1.06 - 1.21)

< 0.001

Atrial fibrillation

1.26 (1.17 - 1.36)

< 0.001

1.93 (1.80 - 2.06)

< 0.001

Heart failure

2.03 (1.89 - 2.18)

< 0.001

2.55 (2.38 - 2.72)

< 0.001

Hypertension

0.51 (0.47 - 0.55)

< 0.001

0.59 (0.54 - 0.64)

< 0.001

Diabetes mellitus

1.00 (0.93 - 1.08)

> 0.9

0.90 (0.85 - 0.96)

0.002