الفهرس | Only 14 pages are availabe for public view |
Abstract besity is a recognized health problem in numerous countries around the world. Although obesity has been implicated as a traditional risk factor for coronary artery disease, several studies revealed that obese patients with acute coronary syndrome may have a better outcome – what is called the (obesity paradox). By contrast, these data were not supported by other fewer studies generating considerable debate in recent literature. Methods: We evaluated 140 patients admitted to the coronary care unit of Ain shams university and Ain shams university specialized hospitals with acute ST elevation myocardial infarction (STEMI) to investigate the impact of body mass index on presentation and outcome of STEMI. Patients were classified by body mass index (BMI) according to WHO criteria into obese group (BMI ≥ 30 Kg/m2) (n=76) and non obese group (BMI < 30) (n=64). Presence of abdominal obesity was assessed in all patients (waist circumference is > 102 cm in males, and > 88 cm in females) (n=75). The main points of concern were the demographic data (Age, sex, weight, height and waist circumference), risk factors, history of medications, clinical presentation regarding killip class and site of infarction, reperfusion strategy, echocardiographic parameters including Ejection fraction, wall motion score index and presence of mitral regurgitation as a mechanical complication, coronary angiography regarding the culprit vessel affection and severity of coronary artery disease and the in hospital complications. Results: The obese patients were younger in age than the non obese patients. The obese group had higher prevalence of hypertension, diabetes mellitus and dyslipidemia. The obese patients were more likely to be on anti platelet and anti ischemic medications before presentation. The obese patients were presented earlier than the non obese patients affecting significantly their prognosis. The obese patients had better clinical presentation than the non obese patients as regard killip class. The non obese patients presented in killip class II were more than the obese patients and this was statistically significant. Regarding the echo findings, the occurrence of MR was significantly higher in the non obese group compared to the obese In our study, we found that the non obese patients were having in hospital complications 4 times more than the obese patients and patients with normal waist circumference were having complications as twice as the patients with high waist circumference. Patients who had both factors (low BMI and normal waist circumference) were found to have the worst prognosis. They had complications 5 times more than patients who had high BMI and high waist circumference. |