Influence of obesity in patients admitted with acute coronary syndrome to the intensive care unit

Objective

To analyze the characteristics of obese patients admitted with acute coronary syndrome (ACS) to an ICU.

Materials and methods

From October 2003 to December 2006, 501 patients with ACS were admitted to the ICU. The data collection was made prospectively. The follow-up was made 6 months after initial hospitalization for evaluation of later death, new cardiac hospital admission and persistence of symptoms after the coronary event. Statistic analysis was performed with Fisher's exact test and the Mann–Whitney test.

Results

Ninety-six patients with obesity (BMI ≥30 kg/m²) were analyzed. The mean age was 61.8 years old (43–90 years), being significantly lower in obese patients than in nonobese patients (P < 0.001). Seventy-seven percent of the patients were men (74 patients) (P < 0.0001); 35.4% of the patients had unstable angina, 30.2% had non-ST-segment elevation myocardial infarction (NSTEMI) and 24.3% had ST-segment elevation myocardial infarction (STEMI). The most common risk factors were hypertension (78.1%) (P = 0.062), followed by sedentarism (66.6%) (P = 0.01), dyslipidemia (43.7%) (P = 0.49) and diabetes (29.1%) (P = 0.70). Previous angina was related by 40 patients (P = 0.07) and previous myocardial infarction by 36 (P = 0.29). Nine patients had previous stent (P = 0.85) and 19 previous coronary artery bypass graft surgery (CABG) (P = 0.36). At admission, 88.5% related precordial pain. Coronariography was made in 81 patients, with 36 submitted to angioplasty (34 with stent). The most affected coronary was the anterior descending (64.1%) followed by the right coronary (51.8%) and the circumflex (27.1%). Thrombolytic was used in 14 patients and 15 were submitted to CABG. Forty-four patients received only clinical treatment. The hospital mortality was significantly lower in obese patients (2.0%) than in nonobese patients (11.6%). The mean time of stay in the ICU was 2.38 days (P = 0.37) and the hospital stay was 9.53 days (P = 0.58). Follow-up was made with 78.3% (65 of 83 patients). The later mortality by cardiac causes was 1.5%. There was 19 new hospital admissions for cardiac causes and 15 had persistence of symptoms.

Conclusion

Obesity predisposes to a higher risk of cardiovascular disease in the young population. Nevertheless, mortality was lower, probably because of the lower mean age of this obese group with ACS.