Body Mass Index and New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction

Figures & data

Table 1 Clinical Characteristics According to BMI Categories

	BMI (kg/m^2)				P value
	<23.0	23.0–24.9	25.0–29.9	≥30.0
	N = 985	N = 964	N = 1898	N = 435
Male (%)	635 (64.5)	752 (78.0)	1456 (76.7)	333 (76.6)	<0.001
Age (years)	68.2±11.9	64.9±11.8	62.5±12.0	58.3±13.3	<0.001
SBP (mmHg)	127.1±22.0	128.6±21.6	129.0±21.9	134.8±22.1	<0.001
DBP (mmHg)	71.5±12.0	73.5±11.9	74.1±12.6	78.0±14.1	<0.001
Heart rate (bpm)	73 (65, 83)	73 (65, 84)	73 (64, 82)	74 (65, 83)	0.230
STEMI (%)	512 (52.0)	474 (49.2)	952 (50.2)	196 (45.1)	0.110
Killip II–IV (%)	314 (31.9)	244 (25.3)	453 (23.9)	90 (20.7)	<0.001
Medical history
Hypertension (%)	583 (59.2)	568 (58.9)	1280 (67.4)	331 (76.1)	<0.001
DM (%)	356 (36.1)	356 (36.9)	745 (39.3)	172 (39.5)	0.307
CHD (%)	276 (28.0)	270 (28.0)	515 (27.1)	114 (26.2)	0.941
OMI (%)	126 (12.8)	96 (10.0)	213 (11.2)	35 (8.0)	0.040
CABG (%)	11 (1.1)	19 (2.0)	26 (1.4)	7 (1.6)	0.439
Stroke (%)	192 (19.5)	134 (13.9)	292 (15.4)	65 (14.9)	0.005
Current/ex-smoker (%)	547 (55.5)	605 (62.8)	1219 (64.2)	296 (68.0)	<0.001
Laboratory values
WBC (×10^9/L)	7.5 (5.8, 9.1)	7.9 (6.4, 9.8)	8.0 (6.4, 10.0)	8.6 (6.9, 10.3)	<0.001
HsCRP (mg/l)	5.7 (1.7, 18.6)	5.7 (2.0, 17.7)	6.6 (2.3, 17.1)	8.2 (3.1, 18.6)	0.001
eGFR (mL/kg/m^2)	82.0 (60.1, 97.5)	85.1 (68.0, 98.8)	84.8 (69.3, 100.6)	86.2 (69.2, 102.8)	<0.001
FBG (mmol/l)	5.5 (4.7, 7.3)	5.8 (4.9, 7.6)	5.9 (5.1, 7.8)	5.9 (5.1, 7.8)	<0.001
TC (mmol/l)	4.2 (3.6, 5.0)	4.3 (3.7, 5.1)	4.5 (3.8, 5.1)	4.6 (3.9, 5.2)	<0.001
Triglyceride (mmol/l)	1.2 (0.9, 1.6)	1.4 (1.0, 1.9)	1.5 (1.2, 2.2)	1.8 (1.3, 2.5)	<0.001
LDL-C (mmol/l)	2.4 (1.9, 3.0)	2.5 (2.0, 3.0)	2.6 (2.1, 3.1)	2.7 (2.2, 3.2)	<0.001
HDL-C (mmol/l)	1.1 (0.9, 1.3)	1.0 (0.9, 1.2)	1.0 (0.9, 1.1)	1.0 (0.8, 1.1)	<0.001
Angiography values
LM (%)	110 (11.2)	126 (13.1)	201 (10.6)	32 (7.4)	0.015
Triple-vessel (%)	2768 (64.6)	84 (63.6)	2684 (64.7)	2684 (64.7)	0.806
CTO (%)	29 (2.9)	34 (3.5)	67 (3.5)	15 (3.4)	0.856
PCI (%)	673 (68.3)	738 (76.6)	1530 (80.6%)	340 (78.2)	<0.001
Echocardiographic values
LA (cm)	3.5 (3.3, 3.9)	3.7 (3.4, 4.0)	3.8 (3.5, 4.1)	4.0 (3.7, 4.3)	<0.001
LVEDD (cm)	5.0 (4.7, 5.4)	5.1 (4.8, 5.5)	5.2 (4.9, 5.5)	5.3 (5.0, 5.7)	<0.001
E/A	0.83 (0.69, 1.19)	0.83 (0.70, 1.16)	0.84 (0.70, 1.20)	0.90 (0.73, 1.22)	0.038
E/A<1	605 (65.2)	605 (66.3)	1152 (63.5)	243 (58.0)	0.024
Abnormal anterior wall motion (%)	282 (28.6)	259 (26.9)	446 (23.5)	92 (21.1)	0.003
LVEF	0.60 (0.51, 0.66)	0.61 (0.52, 0.66)	0.61 (0.54, 0.66)	0.61 (0.54, 0.66)	0.017

Abbreviations: BMI, body Mass Index; SBP, systolic blood pressure; DBP, diastolic blood pressure; STEMI, ST-segment elevation myocardial infarction; DM, diabetes mellitus; CHD, coronary heart disease; OMI, old myocardial infarction; GABG, coronary artery bypass graft; WBC, white blood cells; hsCRP, hypersensitivity C-reactive protein; eGFR, estimated glomerular filtration rate; FBG, fasting blood glucose; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol. LM, left main trunk; PCI, percutaneous coronary intervention; CTO, chronic total occlusion; LA, left atrium; LVEDD, left ventricular end-diastolic dimension; E/A ratio of early to late ventricular filling velocities, LVEF, left ventricular ejection fraction.

Table 2 Myocardial Injury Markers According to BMI Categories

	BMI (kg/m^2)				P value
	<23.0	23.0–24.9	25.0–29.9	≥30.0
	N = 985	N = 964	N = 1898	N = 435
CK (U/L)	288.0 (111.0, 915.0)	362.0 (134.0, 1260.0)	365.0 (132.0, 1083.5)	349.0 (144.0, 1065.0)	0.001
pCKMB (ng/mL)	17.1 (3.9, 102.0)	24.5 (4.7, 131.5)	24.5 (4.4, 121.0)	26.8 (4.7, 117.5)	0.059
pTNI (ng/mL)	6.0 (0.9, 29.4)	8.2 (1.1, 40.3)	7.7 (1.1, 34.1)	7.3 (1.2, 32.7)	0.069
pNT-proBNP (pg/mL)	2162.5 (706.7, 197.8)	1549.0 (520.5, 4331.3)	1116.5 (409.8, 3099.8)	880.0 (296.5, 2415.8)	<0.001

Abbreviations: BMI, body Mass Index; CK, creatine kinase; pCKMB, peak value of creatine kinase isoenzyme-MB; pTNI, peak value of troponin I; pNT-proBNP, peak value of N-terminal pro-B-type natriuretic peptide.

Figure 1 NOAF risk in different BMI categories.

Abbreviations: NOAF, new-onset atrial fibrillation; BMI, body Mass Index.

Table 3 Cox Proportional Hazard Regression Analysis of NOAF

BMI (kg/m^2)	Model 1		Model 2		Model 3
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
≥30.0	Reference		Reference		Reference
25.0–29.9	1.077 (0.506–2.291)	0.848	1.267 (0.591–2.717)	0.544	1.281 (0.597–2.750)	0.525
23.0–24.9	1.612 (0.747–3.477)	0.224	2.266 (1.042–4.924)	0.039	2.253 (1.031–4.920)	0.042
<23.0	1.636 (0.762–3.515)	0.207	2.776 (1.264–6.097)	0.011	2.884 (1.302–6.392)	0.009
Continuous (per SD)	0.946 (0.900–0.995)	0.030	0.906 (0.860–0.954)	<0.001	0.899 (0.851–0.949)	<0.001

Notes: Model 1 adjusted for sex and age. Model 2 adjusted for sex, age, LA, Killip (II–IV) and CTO. Model 3 adjusted for sex, age, LA, Killip (II–IV) and CTO, eGFR, triglyceride, pNT-proBNP and pTNI.

Abbreviations: NOAF, new-onset atrial fibrillation; BMI, body mass index; eGFR, estimated glomerular filtration rate; CTO, chronic total occlusion; pTNI, peak value of troponin I; pNT-proBNP, peak value of N-terminal pro-B-type natriuretic peptide; LA, left atrium.

Figure 2 Continue.

Figure 2 Effects of BMI on NOAF by prespecified subgroups. Prespecified subgroups of interest in this analysis are age (A), sex (B), diabetes mellitus (C), STEMI (D), hypertension (E) and LVEF (F). Adjusted for sex, age, LA, Killip (II–IV) and CTO, eGFR, triglyceride, pNT-proBNP and pTNI.

Abbreviations: NOAF, new-onset atrial fibrillation; BMI, body Mass Index; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; LVEF, left ventricular ejection fraction; LA, left atrium; eGFR, estimated glomerular filtration rate; CTO, chronic total occlusion; pTNI, peak value of troponin I; pNT-proBNP, peak value of N-terminal pro-B-type natriuretic peptide.

Figure 3 Kaplan–Meier curve for all-cause mortality (A) and cardiac mortality (B).

Abbreviations: NOAF, new-onset atrial fibrillation; BMI, body Mass Index.