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ObjectivesBecause excess adiposity is one of the most important determinants of adipokines and inflammatory factors associated with coronary plaque rupture, we hypothesized that obesity was associated with myocardial infarction at earlier ages.BackgroundThe developing obesity pandemic of the past 50 years has gained considerable attention as a major public health threat.MethodsThe CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) registry was a voluntary observational data collection and quality improvement initiative that began in November 2001, with retrospective data collection from January 2001 to January 2007. The CRUSADE initiative included high-risk patients with unstable angina and non–ST-segment elevation myocardial infarction (NSTEMI). We retrospectively examined, among 189,065 patients with acute coronary syndrome (between January 2001 and September 2006) in the CRUSADE initiative, the relationship of body mass index (BMI) with patient age of first NSTEMI.ResultsA total of 111,847 patients with NSTEMI were included in the final analysis. There was a strong, inverse linear relationship between BMI and earlier age of first NSTEMI. The mean patient ages (± SD) of first NSTEMI were 74.6 ± 14.3 years and 58.7 ± 12.5 years for the leanest (BMI ≤18.5 kg/m2) and most obese (BMI >40.0 kg/m2) cohorts, respectively (p < 0.0001). After adjustment for baseline demographic data, cardiac risk factors, and medications, the age of first NSTEMI occurred 3.5, 6.8, 9.4, and 12.0 years earlier with ascending levels of adiposity (BMI 25.1 to 30.0, 30.1 to 35.0, 35.1 to 40.0, and >40.0 kg/m2, respectively; referent 18.6 to 25.0 kg/m2) (p < 0.0001 for each estimate).ConclusionsExcess adiposity is strongly related to first NSTEMI occurring prematurely.

Objectives We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS). Background Creatine kinase-MB (CK-MB) and cardiac troponins (cTn) are often measured concurrently in patients with NSTE ACS. The significance of discordant CK-MB and cTn results is unknown. Methods Among 29,357 ACS patients in the CRUSADE initiative who had both CK-MB and cTn measured during the first 36 hours, we examined relationships of four marker combinations (CK-MB−/cTn−, CK-MB+/cTn−, CK-MB−/cTn+, and CK-MB+/cTn+) with mortality and American College of Cardiology/American Heart Association guidelines-recommended acute care. Results The CK-MB and cTn results were discordant in 28% of patients (CK-MB+/cTn−, 10%; CK-MB−/cTn+, 18%). In-hospital mortality was 2.7% among CK-MB−/cTn− patients; 3.0%, CK-MB+/cTn−; 4.5%, CK-MB−/cTn+; and 5.9%, CK-MB+/cTn+. After adjustment for other presenting risk factors, patients with CK-MB+/cTn− had a mortality odds ratio (OR) of 1.02 (95% confidence interval [CI] 0.75 to 1.38), those with CK-MB−/cTn+ had an OR of 1.15 (95% CI 0.86 to 1.54), and those with CK-MB+/cTn+ had an OR of 1.53 (95% CI 1.18 to 1.98). Despite variable risk, patients with CK-MB+/cTn− and CK-MB−/cTn+ were treated similarly with early antithrombotic agents and catheter-based interventions. Conclusions Among patients with NSTE ACS, an elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MB+ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all cTn+ patients.