Effect of Body Mass Index in Patients With Cardiogenic Shock Requiring Microaxial Flow Pump

Effect of Body Mass Index in Patients With Cardiogenic Shock Requiring Microaxial Flow PumpJACC: Asia. May 04, 2025. Epublished DOI:10.1016/j.jacasi.2025.03.003AbstractBackgroundThe impact of obesity on mortality in patients with cardiogenic shock (CS) requiring microaxial flow pumps (mAFP) remains undetermined. ObjectivesThis study investigated the effect of body mass index (BMI) on mortality in CS patients treated with microaxial flow pumps MethodsData from 3,636 consecutive CS patients treated with Impella microaxial flow pumps in the J-PVAD (Japanese Registry for Percutaneous Ventricular Assist Device) nationwide prospective registry in Japan between February 2020 and December 2022 were analyzed. Patients werestratified into 5 BMI categories: underweight (<18.5 kg/m2),normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obesity (25.0-29.9 kg/m2), and severe obesity (≥30.0 kg/m2). Multivariate Cox regression analysis assessed the relationship between BMI and 30-day mortality. ResultsCrude 30-day mortality increased incrementally with higher BMI categories. Adjusted HRs for 30-day mortality(normal weight as reference) were 0.71 (95% CI [CI]: 0.56-0.90; P = 0.005) for underweight, 1.03 (95%CI: 0.88-1.21; P = 0.681) for overweight, 1.37 (95% CI: 1.19-1.57; P < 0.001) for obesity, and 2.00 (95% CI: 1.66-2.41; P < 0.001) for severe obesity. Patients in the underweight and severe obesity groups experienced a higher incidence of bleeding after percutaneous coronary intervention under microaxial flow pumps, whereas hemolysis increased withhigher BMI categories. Bleeding and hemolysis were associated with mortality only in patients who were underweight. ConclusionsHigher BMI was associated with increased mortality in CS patients treated with microaxial flow pumps. Although patients who were underweight demonstrated overall favorable survival outcomes, bleeding and hemolysis contributed to mortality in this group. Further research isneeded to explore whether a BMI-based approach can improve clinical outcomes. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.