The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography.

Background and Aim. Obesity is associated with an increased risk of cardiovascular disease and may be associated with more severe coronary artery disease (CAD); however, the relationship between body mass index [BMI (kg/m2)] and CAD severity is uncertain and debatable. The aim of this study was to examine the relationship between BMI and angiographic severity of CAD. Methods. Duke Jeopardy Score (DJS), a prognostic tool predictive of 1-year mortality in CAD, was assigned to angiographic data of patients ≥18 years of age (N = 8,079). Patients were grouped into 3 BMI categories: normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2); and multivariable adjusted hazard ratios for 1-year all-cause and cardiac-specific mortality were calculated. Results. Cardiac risk factor prevalence (e.g., diabetes, hypertension, and hyperlipidemia) significantly increased with increasing BMI. Unadjusted all-cause and cardiac-specific 1-year mortality tended to rise with incremental increases in DJS, with the exception of DJS 6 (p < 0.001). After adjusting for potential confounders, no significant association of BMI and all-cause (HR 0.70, 95% CI .48-1.02) or cardiac-specific (HR 1.11, 95% CI .64-1.92) mortality was found. Conclusions. This study failed to detect an association of BMI with 1-year all-cause or cardiac-specific mortality after adjustment for potential confounding variables.

Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada.

Background and Aim. Obesity (BMI ≥ 30 kg/m(2)) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL. Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (n = 1073); overweight, 25.0 ≤ BMI < 30 (n = 2608); and obese, BMI ≥ 30.0 (n = 2792). Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%, p = 0.001). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%, p = 0.386) or postprocedural (1.0%, 0.8%, and 0.9%, p = 0.725) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes. Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI.

Use of evidence-based therapy at discharge for patients with acute myocardial infarction: retrospective audit of medical records.

BACKGROUND: Various guidelines are available outlining optimal therapy for patients with acute myocardial infarction. Canadian institutions providing care for such patients have been encouraged to evaluate their care processes using specific indicators. OBJECTIVE: To determine the proportion of patients with acute myocardial infarction discharged from a single health authority for whom acetylsalicylic acid (ASA), adrenergic ß-receptor antagonists (ß-blockers), angiotensin-converting enzyme (ACE) inhibitors, or 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) had been prescribed. METHODS: Patients treated over a 12-month period (April 1, 2004, to March 31, 2005) for whom the most responsible diagnosis was acute myocardial infarction were eligible for inclusion in this review. Retrieved data included diagnosis, demographic information, comorbidities, and medications at the time of admission and discharge. Rates of discharge prescribing for the 4 drug classes were calculated for all patients and for "ideal" patients (those without documented contraindications). Rates were compared with published benchmark values. RESULTS: Medical records for a total of 346 eligible patients were reviewed. Mean age was 65.3 years (standard deviation 13.4 years), and 226 (65.3%) of the patients were male. The coded diagnosis was ST-elevation myocardial infarction for 91 patients (26.3%), non-ST-elevation myocardial infarction for 164 (47.4%), and myocardial infarction not specified for 91 (26.3%). For "ideal" patients, the prescribing rates were 99.0% (308 of 311 patients) for ASA, 96.3% (310 of 322 patients) for ß-blockers, 90.4% (264 of 292 patients) for ACE inhibitors, and 88.8% (278 of 313 patients) for statins. CONCLUSIONS: Rates of prescribing of ASA, ß-blockers, ACE inhibitors, and statins for "ideal" patients discharged after treatment for acute myocardial infarction exceeded the published Canadian benchmark rates (≥ 90% for ASA, ≥ 85% for ß-blockers and ACE inhibitors, ≥ 70% for statins).

The effect of place of residence on access to invasive cardiac services following acute myocardial infarction.

BACKGROUND: The Canadian health care system is mandated to provide reasonable access to health care for all Canadians regardless of age, sex, race, socioeconomic status or place of residence. In the present study, the impact of place of residence in Nova Scotia on access to cardiac catheterization and long-term outcomes following an acute myocardial infarction (MI) were examined. METHODS: All patients with an acute MI who were hospitalized between April 1998 and December 2001 were identified. Place of residence was defined by postal code and separated into three categories: metropolitan area (MA); nonmetropolitan urban area (UA); and rural area (RA). Rates of and waiting times for cardiac catheterization were determined, as were risk-adjusted long-term rates of mortality and readmission to the hospital. RESULTS: A total of 7351 patients were hospitalized with an acute MI during the study period. Rates of cardiac catheterization differed across the three groups (MA 45.6%, UA 37.3%, RA 37.3%; P<0.0001), as did mean waiting times (MA 15.0 days, UA 32.1 days, RA 28.7 days) (P<0.0001). After adjusting for differences among patients, residence in either UA or RA emerged as an independent predictor of lower rates of cardiac catheterization (UA: hazard ratio [HR] 0.77, P<0.0001; RA: HR 0.75, P<0.0001), greater waiting times (UA: an additional 14.1 days, P<0.0001; RA: an additional 10.8 days, P<0.0001) and increased long-term rates of readmission (UA: HR 1.24, P=0.0001; RA: HR 1.12, P=0.04). CONCLUSION: In patients admitted with an acute MI, residence outside of an MA was associated with diminished rates of cardiac catheterization, longer waiting times and increased rates of readmission. Despite universal health care coverage, Canadians are subject to significant geographical barriers to cardiac catheterization with associated poorer outcomes.

Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era?

OBJECTIVES: This study was designed to assess the prognostic significance of hyperglycemia in acute myocardial infarction (AMI) in the thrombolytic era using contemporary criteria for hyperglycemia. BACKGROUND: Most studies that have examined this issue were performed before the widespread use of disease-modifying therapies and varied in their definition of hyperglycemia, assessment of risk factors, and reported outcomes. METHODS: There were 1,664 consecutively hospitalized patients with AMI between October 1997 and October 1998 from a disease-specific, population-based registry. Patients were stratified according to history of diabetes mellitus and, further, according to whether they had a blood glucose >198 mg/dl (11 mmol/l). The influences of cardiac risk factors, medications, and interventions were analyzed, and multivariate logistic regression was used to determine the influence of blood glucose on mortality. RESULTS: In patients without a history of diabetes, glucose levels were < or =198 mg/dl in 1,078 patients (Group 1) and >198 mg/dl in 135 (Group 2). Of those with diabetes, glucose levels were < or =198 mg/dl in 169 patients (Group 3) and >198 mg/dl in 282 (Group 4). Compared with Group 1 patients, the odds ratios (95% confidence interval) for in-hospital mortality among those in Groups 2, 3, and 4 were 2.44 (1.42 to 4.20; p = 0.001), 1.87 (1.05 to 3.34; p = 0.035), and 1.91 (1.16 to 3.14; p = 0.011), respectively. These groups also had greater 12-month mortality. CONCLUSIONS: Hyperglycemia in AMI is associated with poor outcome even among patients without known diabetes. This finding underlines the need for aggressive glucose management in this setting and may support a more vigorous screening strategy for early recognition of diabetes.