Temporal trends in management and outcomes of patients with acute coronary syndrome according to body mass index

Background: Obesity is a major public health concern. We sought to investigate temporal trends in characteristics and outcomes of acute coronary syndrome patients according to body mass index. Methods: The study population consisted of patients who were included in the Acute Coronary Syndromes Israeli Surveys during 2000-2016. Patients were categorised into three groups according to body mass index: Below 25 kg/m2, 25-30 kg/m2 (overweight) and above 30 kg/m2 (obese). Among each body mass index group the outcomes of two time frames were compared-early (2000-2006) versus late (2008-2016). Results: Overall 12,167 patients were included. Between the years 2000 and 2016, the percentage of obese patients increased from 20% to 30%. Obese patients were more frequently selected for an invasive approach, and had the lowest all-cause mortality rates. A significant reduction in 1-year mortality in recent compared to early surveys among patients with body mass index less than 25 kg/m2 and in obese patients but not for overweight patients was shown. Multivariable analysis showed that body mass index greater than 25 kg/m2 was associated with 30% lower 1-year mortality (hazard ratio 0.70, 95% confidence interval 0.55-0.90, P=0.005). Conclusion: The prevalence of obesity among acute coronary syndrome patients has increased over the past two decades. A reduction of all-cause mortality was mainly seen in lean and obese patients.