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. 2025 Jul 28.
doi: 10.1007/s00392-025-02717-1. Online ahead of print.

Prognostic impact of body mass index in acute myocardial infarction complicated by cardiogenic Shock: an ECLS-SHOCK subanalysis

Tobias Schupp  1 , Holger Thiele  2 , Tienush Rassaf  3 , Amir Abbas Mahabadi  3 , Ralf Lehmann  4 , Ingo Eitel  5 , Carsten Skurk  6 , Peter Clemmensen  7 , Marcus Hennersdorf  8 , Ingo Voigt  9 , Axel Linke  10 , Eike Tigges  11 , Peter Nordbeck  12 , Christian Jung  13 , Philipp Lauten  14 , Hans-Josef Feistritzer  2 , Maria Buske  2 , Janine Pöss  2 , Taoufik Ouarrak  15 , Steffen Schneider  15 , Michael Behnes  1 , Daniel Duerschmied  1 , Steffen Desch  2 , Anne Freund  2 , Uwe Zeymer  1   15   16 , Ibrahim Akin  17
Affiliations

Prognostic impact of body mass index in acute myocardial infarction complicated by cardiogenic Shock: an ECLS-SHOCK subanalysis

Tobias Schupp et al. Clin Res Cardiol. .

Abstract

Background: The prognostic impact of overweight and obesity in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI) is still a matter of debate. The present subanalysis of the ECLS-SHOCK trial sought to investigate the association between body mass index (BMI) and outcomes in patients with AMI-CS.

Methods: Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of BMI was investigated stratified by BMI 18.5-24.9 kg/m2, 25.0-29.9 kg/m2 and ≥ 30.0 kg/m2 with regard to the primary endpoint 30-day all-cause mortality.

Results: Overall, 407 patients with AMI-CS were included with a median BMI of 27.7 kg/m2 (interquartile range 24.8-30.8 kg/m2). Patients with a BMI ≥ 30.0 kg/m2 (n = 115) were less likely males, had a higher burden of cardiovascular risk factors and higher rates of TIMI flow 0 before revascularization than patients with lower BMI values. The primary endpoint of all-cause mortality at 30 days occurred in 53.9%, 45.3% and 47.7% of patients with BMI ≥ 30.0 kg/m2, 25.0-29.9 kg/m2 and 18.5-24.9 kg/m2, respectively. Using patients with a BMI 18.5-24.9 kg/m2 as a reference, neither a BMI ≥ 30.0 kg/m2 (OR = 1.28; 95% CI 0.76-2.16; p = 0.35) nor a BMI of 25.0-29.9 kg/m2 (OR = 0.91; 95% CI 0.56-1.46; p = 0.68) were associated with an increased risk of all-cause mortality. Similar results were obtained regardless of allocation to extracorporeal life support (ECLS) or medical treatment only for all BMI groups. Safety endpoints did not differ across the different BMI groups.

Conclusion: In this well-defined cohort of patients with AMI-CS, BMI was not associated with the risk of all-cause mortality, nor were we able to identify BMI subgroups who derived more benefit or less harm from ECLS therapy.

Keywords: Acute myocardial infarction; Body mass index; Cardiogenic shock; ECLS; Mortality; Obesity; Overweight.

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Conflict of interest statement

Declarations. Conflict of interest: Tienush Rassaf has received honoraria, lecture fees, and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiicho-Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, all unrelated to this work. He is co-founder of Bimyo GmbH, a company that develops cardioprotective peptides. Peter Clemmensen has previously or currently been involved in research contracts, consulting, speakers bureau or received research and/or educational grants from: Abbott, Abiomed, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, CytoSorbent, Daiichi Sankyo, Eli-Lilly, Evolva, Ferrer, Fibrex, Idorsia, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, ViFor Pharma. Axel Linke has received grants from Novartis and Edwards Lifesciences; personal fees from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Edwards Lifesciences, Medtronic, Meril, Novartis, Sanofi Genzyme, and Pfizer; and other fees from Picardia, Filterlex, and Transverse Medical outside the submitted work. Janine Poess: Research foundation (institutional): German Cardiac Society, German Heart Research Foundation, Dr. Rolf M. Schwiete Foundation, Maquet Cardiopulmonary GmbH. Daniel Duerschmied has received speaker’s honoraria from AOP Health, Bayer Healthcare, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, and Pfizer. Eike Tigges has received honoraria and/or lecture fees from Edwards Lifesciences, Medtronic, Resuscitec, Abiomed, Boston Scientific and Philips. Carsten Skurk has received speaker fees from Abiomed, Abbott, Boston Scientific and Brystol Myers Squibb not related to this work. Ingo Voigt has received speaker’s honoraria from Fresenius Medical Care and Inari Medical. The other authors declare that they do not have any conflict of interest.

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