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Abstract: PO2422

Renal Function and Effect of Body Mass Index on Mortality Risk After Acute Myocardial Infarction

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Kang, Shinyeong, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Jin sug, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
Background

Obesity is paradoxically linked to greater survival benefit after acute myocardial infarction (AMI). In patients with renal impairment, higher body mass index (BMI) is also associated with protective effects against cardiovascular and all-cause mortality. However, there are no studies investigating the interactive effects of BMI and renal function on mortality risk after AMI.

Methods

We enrolled 12,647 AMI patients from Korea Acute myocardial Infarction Registry between November 2011 and December 2015. Patients were categorized based on renal function; normal (≥90 mL/min/1.73m2), mild (90-45 mL/min/1.73m2), and moderate impairment (<45 mL/min/1.73m2). BMI was divided into four groups; underweight (<18.5 kg/m2), ideal (18.5-23 kg/m2), overweight (23-25 kg/m2) and obesity (≥25 kg/m2). The primary endpoint was 2-year mortality after AMI treatment.

Results

In multivariable Cox-regression analysis, compared to Ideal weight patients, overweight and obese patients were associated lower risk of mortality and underweight patients had the increased risk of mortality in all renal function categories. However, the survival effect of each BMI stratum was decreased as renal function worsened. The adjusted mortality risk of obesity was 0.63 (95% CI 0.0.41-0.99), 0.76 (95% CI 0.59-0.97) and 0.84 (95% CI 0.65-1.08) for patients with normal, mild and moderate renal function impairment, respectively. There was a significant interaction between BMI and renal function (P = 0.010). We found that the survival benefit of obesity for noncardiac death was decreased with decreasing renal function (P for interaction = 0.03), but obesity-related advantage was not changed between different renal function (P for interaction = 0.03).

Conclusion

The effect of BMI on mortality risk after AMI was dependent on renal function. The association between greater BMI and survival benefit was weakened as renal function was worsened. We suggest that the association between renal function and effect of BMI on mortality originated in non-cardiac death, not cardiac death.