Table 2.
Presentation Characteristics, Reperfusion Strategy and Medical Therapy, Discharge Medications, Counseling, and Referrals Stratified by BMI Category
| Variable | BMI Category (kg/m2)
|
||||
|---|---|---|---|---|---|
| Normal Weight (18.5 to <25)
|
Overweight (25 to <30)
|
Class I Obese (30 to <35)
|
Class II Obese (35 to <40)
|
Class III Obese (≥40)
|
|
| (n = 11,780) | (n = 19,391) | (n = 11,234) | (n = 4,376) | (n = 2,548) | |
| Initial laboratory values | |||||
| Hemoglobin (g/dl) | 13.8 (12.5–15.0) | 14.4 (13.2–15.4) | 14.5 (13.3–15.6) | 14.5 (13.3–15.6) | 14.3 (13.1–15.5) |
| Total cholesterol (mg/dl) | 161 (134–190) | 168 (141–198) | 172 (143–201) | 173 (145–203) | 171 (145–202) |
| HDL cholesterol (mg/dl) | 39 (32–48) | 35 (30–43) | 34 (29–41) | 33 (28–40) | 34 (29–41) |
| LDL cholesterol (mg/dl) | 97 (74–123) | 103 (79.0–129.6) | 104 (79–130) | 104 (79–130) | 103 (79–130) |
| Triglycerides (mg/dl) | 97 (68–142) | 121 (84–177) | 140 (96–208) | 148 (101–224) | 144 (100–218) |
| Serum creatinine (mg/dl) | 1.1 (0.9–1.2) | 1.1 (0.9–1.3) | 1.1 (0.9–1.3) | 1.1 (0.9–1.2) | 1.1 (0.8–1.2) |
|
| |||||
| Presentation characteristics | |||||
| HF | 1,594 (13.5%) | 2,127 (11.0%) | 1,173 (10.4%) | 506 (11.6%) | 280 (11.0%) |
| Shock | 839 (7.1%) | 1,151 (5.9%) | 579 (5.2%) | 241 (5.5%) | 141 (5.5%) |
| Heart rate (beats/min) | 77 (64–93) | 77 (64–91) | 79 (66–93) | 80 (68–95) | 82 (70–96) |
| SBP (mm Hg) | 134 (113–154) | 138 (118–159) | 141 (120–160) | 142 (121–163) | 143 (122–164) |
| eGFR (ml/min/1.73 m2)* | 71.5 (56.0–88.1) | 72.9 (58.6–88.1) | 72.9 (58.9–87.7) | 73.7 (58.8–89.7) | 74.3 (58.9–91.8) |
| Number of diseased vessels† | |||||
| No significant disease | 338 (3.2%) | 432 (2.4%) | 214 (2.0%) | 107 (2.6%) | 72 (3.1%) |
| 1 | 3,819 (36.4%) | 6,782 (37.6%) | 4,113 (39.3%) | 1,605 (39.2%) | 1,029 (44.1%) |
| 2 | 3,323 (31.6%) | 5,765 (32%) | 3,305 (31.6%) | 1,339 (32.7%) | 699 (30.0%) |
| 3 | 2,983 (28.4%) | 4,978 (27.6%) | 2,781 (26.6%) | 1,036 (25.3%) | 522 (22.4%) |
| LV ejection fraction (%)‡ | |||||
| ≥50 | 4,629 (43.1%) | 8,645 (48.3%) | 5,093 (49.3%) | 2,062 (51.3%) | 1,171 (51.0%) |
| 40–50 | 2,789 (26.0%) | 4,743 (26.5%) | 2,722 (26.3%) | 1,019 (25.3%) | 632 (27.6%) |
| 25–40 | 2,476 (23.0%) | 3,552 (19.8%) | 1,991 (19.3%) | 764 (19.0%) | 377 (16.4%) |
| >25 | 751 (7.0%) | 839 (4.7%) | 447 (4.3%) | 146 (3.6%) | 86 (3.7%) |
|
| |||||
| Reperfusion strategy§ | |||||
| Overall reperfusion | 8,715 (92.3%) | 15,475 (93.5%) | 9,020 (93.9%) | 3,502 (93.5%) | 1,978 (93%) |
| Thrombolytic therapy | 1,212 (12.8%) | 2,311 (13.9%) | 1,356 (14%) | 554 (14.7%) | 304 (14.1%) |
| Primary PCI | 7,627 (80.8%) | 13,398 (80.9%) | 7,801 (81.2%) | 2,996 (80%) | 1,711 (80.4%) |
| Arrival to primary PCI (min)|| | 69 (53–87) | 68 (52–85) | 68 (53–86) | 69 (54–87) | 73 (58–90) |
| CABG | 766 (7.2%) | 1,388 (7.7%) | 815 (7.8%) | 291 (7.1%) | 147 (6.3%) |
| Arrival to CABG (h) | 41.0 (68.0–100.1) | 38.6 (52.0–90.9) | 38.1 (46.0–90.1) | 54.9 (69.0–120.5) | 45.9 (82.0–132.8) |
|
| |||||
| Medications within 24 h§ | |||||
| Aspirin | 11,253 (97.9%) | 18,721 (98.5%) | 10,880 (98.7%) | 4,232 (98.8%) | 2,436 (98.1%) |
| Clopidogrel | 9,471 (85.6%) | 16,318 (88.7%) | 9,487 (89%) | 3,687 (88.2%) | 2,108 (87.4%) |
| Beta-blocker | 9,263 (94.2%) | 16,027 (95.5%) | 9,581 (96.1%) | 3,747 (95.2%) | 2,170 (95.5%) |
| ACE inhibitors or ARBs | 5,347 (50.8%) | 9,945 (55.6%) | 6,209 (59.6%) | 2,435 (59.8%) | 1,435 (60.6%) |
| Aldosterone-blocking agents | 228 (2.0%) | 327 (1.8%) | 208 (1.9%) | 85 (2.0%) | 57 (2.3%) |
| Statins | 7,407 (66.3%) | 12,981 (69.9%) | 7,608 (70.5%) | 2,928 (69.6%) | 1,683 (68.9%) |
| Glycoprotein IIb/IIIa inhibitors | 7,532 (68.9%) | 13,495 (73.4%) | 8,035 (75.1%) | 3,092 (74.0%) | 1,737 (71.9%) |
| Heparin¶ | |||||
| None | 1,241 (10.7%) | 1,898 (9.9%) | 1,128 (10.1%) | 417 (9.6%) | 253 (10.0%) |
| Low–molecular weight | 1,138 (9.8%) | 1,683 (8.8%) | 1,014 (9.1%) | 435 (10.0%) | 218 (8.6%) |
| Unfractionated | 8,316 (71.9%) | 14,268 (74.4%) | 8,223 (74%) | 3,161 (72.9%) | 1,859 (73.7%) |
| Both | 822 (7.1%) | 1,268 (6.6%) | 721 (6.5%) | 305 (7.0%) | 178 (7.1%) |
| Bivalirudin¶ | 1,581 (13.7%) | 2,787 (14.5%) | 1,620 (14.6%) | 623 (14.4%) | 382 (15.1%) |
|
| |||||
| Discharge medications§ | |||||
| Aspirin | 9,813 (98.4%) | 16,909 (98.6%) | 9,865 (98.7%) | 3,837 (98.9%) | 2,157 (98.2%) |
| Clopidogrel | 8,830 (90.2%) | 15,542 (92.1%) | 9,105 (92.1%) | 3,498 (91.8%) | 1,995 (91.9%) |
| Warfarin | 830 (8.1%) | 1,267 (7.3%) | 725 (7.1%) | 285 (7.2%) | 147 (6.6%) |
| Beta-blockers | 9,343 (96.5%) | 16,372 (97.5%) | 9,612 (97.6%) | 3,742 (97.9%) | 2,113 (97.2%) |
| ACE inhibitors or ARBs | 2,045 (85%) | 3,094 (87.7%) | 1,788 (88.7%) | 645 (88.6%) | 336 (89.6%) |
| Aldosterone-blocking agents | 329 (8.2%) | 495 (7.4%) | 333 (7.5%) | 135 (7.1%) | 79 (6.6%) |
| Statins | 9,050 (90.8%) | 16,011 (93.7%) | 9,379 (93.8%) | 3,647 (94.2%) | 2,033 (91.9%) |
|
| |||||
| Discharge interventions§ | |||||
| Smoking cessation counseling | 4,639 (96.9%) | 7,522 (96.8%) | 4,316 (97.0%) | 1,683 (96.7%) | 926 (96.4%) |
| Diet modification counseling | 9,567 (93.6%) | 16,535 (94.7%) | 9,711 (95.2%) | 3,765 (95.2%) | 2,148 (95.6%) |
| Cardiac rehabilitation referral | 7,456 (79.9%) | 13,494 (81.4%) | 7,944 (81.9%) | 3,112 (82.4%) | 1,758 (82.6%) |
| Exercise counseling | 8,819 (86.9%) | 15,331 (88.1%) | 9,038 (89%) | 3,533 (89.8%) | 1,961 (87.7%) |
Values are median (interquartile range) or n (%).
*
Estimated using the MDRD (Modification of Diet in Renal Disease) formula. Excludes dialysis patients.
†
Among patients who underwent cardiac catheterization.
‡
Among patients who had LV ejection fraction measured.
§
Among eligible patients.
||
Excludes transfer-in patients.
¶
Any time during hospital stay.
ARB = angiotensin receptor blocker; eGFR = estimated glomerular filtration rate; HDL = high-density lipoprotein; HF = heart failure; LDL = low-density lipoprotein; SBP = systolic blood pressure; other abbreviations as in Table 1.