Obesity Paradox Occurs in Non-ST-elevation Myocardial Infarction for Overweight and Obesity but Not for Morbid Obesity.

Introduction: The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate if obesity has a protective effect in patients presenting with non-ST-elevation myocardial infarction (NSTEMI). Methods: Using a large Nationwide Inpatient Sample (NIS) database, we evaluated mortality in patients with NSTEMI based on weight categories in adults. Results: A total of 3,597,279 NSTEMI patients were found in the database over the age of 18 years. We found that overweight and obesity, followed by morbid obesity, had the lowest mortality using univariate (overweight mortality of 3.2% vs. obesity mortality of 3.78% vs. morbid obesity mortality of 5.69% vs. 7.8% of normal weights), whereas cachexia was associated with the highest mortality in univariate analysis (cachexia 21.82%). Using multivariate analysis adjusting for baseline characteristics and comorbidities, those relations remained unchanged (cachexia Multivariate Odds ratio (MVOR): 2.56, confidence interval [CI]: 2.41-2.73, P < 0.001; overweight MVOR: 0.49, CI: 041-0.59, P < 0.001; obesity MVOR: 0.6, CI: 0.58-0.63, P < 0.001; and morbid obesity MVOR: 0.94, CI: 0.9-0.98, P = 0.004). Conclusion: We observe an obesity paradox in patients with NSTEMI, showing that overweight, followed by obesity and morbid obesity, have the lowest mortality, with cachexia having the highest mortality.