Obesity is a major risk factor for cardiovascular disease, but evidence regarding the impact of metabolic obesity phenotypes on the prognosis of acute coronary syndrome (ACS) remains insufficient.

Exploring the impact of diverse metabolic obesity phenotypes on the pognosis of prcutaneous coronary intervention (PCI) in ACS patients.

This study employed a prospective cohort design, consecutively enrolling patients who presented with chest pain at the First Affiliated Hospital of Xinjiang Medical University between June 2012 and June 2023, were diagnosed with ACS, and underwent PCI within 12 hours of symptom onset. Baseline data collected included general demographic characteristics, anthropometric measurements, laboratory test results, imaging findings, and procedural details. Participants were categorized into four groups based on the presence of obesity and metabolic syndrome: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). All patients underwent follow-up via telephone and/or outpatient visits every 12 months post-procedure to record major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, stroke, rehospitalization for unstable angina, and heart failure recurrence. Kaplan-Meier survival curves were used to analyze MACCE incidence across the four groups, with log-rank tests for comparisons. Multivariate Cox proportional hazards regression models were employed to assess the association between metabolic obesity phenotypes and MACCE risk.

A total of 1 913 ACS patients were included in this study, with an average age of (58.8±12.1) years. Among them, there were 1 588 males (83.0%) and 325 females (17.0%).There were 612 cases in the MHNW group, 878 cases in the MUNW group, 105 cases in the MHO group, and 318 cases in the MUO group. There were statistically significant differences in the comparison of age, gender, BMI, the prevalence of hypertension diabetes, and proportion of smoking, admission systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood glucose, hemoglobin concentration, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, urea, uric acid, and direct bilirubin levels among the 4 groups (P<0.05). Median follow-up time was 4.77 (2.26, 7.16) years, with 136 patients (7.1%) lost to follow-up. A total of 656 cases (34.3%) of MACCE occurred. There were statistically significant differences in the incidence of MACCE and the incidence of readmission for unstable angina pectoris between the 4 groups (P<0.05). Kaplan-Meier survival curve analysis showed that the difference in Cumulative risk probability of MACCE among the four groups was statistically significant (χ²=26.23, P<0.001). Multivariate Cox regression analysis showed that after adjustment for age, sex, smoking, SBP, DBP, TG, HDL-C, LDL-C, urea, and uric acid, the risks of MACCE in the MHO, MUNW, and MUO groups were 1.56, 1.28, and 1.94 times that of the MHNW group, respectively (P<0.05). The results of the sensitivity analysis demonstrated the stability of the association between metabolically obese phenotypes and the risk of developing MACCE in the prognosis.

Obesity significantly increases the risk of long-term adverse outcomes in patients with ACS undergoing PCI regardless of metabolic status, and the risk is even higher in those with concurrent metabolic abnormalities. Clinical management should emphasize the long-term adverse effects of obesity, and stratified evaluation and individualized intervention should be performed in combination with metabolic status.