**3. Acute coronary syndrome**

The essential difference between stable coronary artery disease and an acute myocardial infarction is the existence of a pro‐inflammatory state with different forms of hemodynamic, rhythmogenic, and hemostatic disturbance in the latter. Although the "obesity paradoxon" phenomenon has been evaluated in the patient population, there is lack of homogenous data establishing a potential link between BMI and clinical events in patients with acute myocardial infarction. Data analyses of the 6359 acute coronary syndrome (ACS) patients included in the PREMIER and TRIUMPH registries drawn to establish a relationship between BMI and survival rate yielded novel results [22]. BMI and mortality rates shared an inverse relationship (9.2% vs. 6.1% vs. 4.7%; *p* < 0.001) irrespective of demographic age and sex distribution. The KAMIR registry yielded similar results in its 3824 ST‐elevation myocardial infarction patient collective [23]. The baseline characteristics defined an older group of normal weight patients, with impairment of left ventricular ejection fraction and having a higher comorbidity index. The study eventually summarized that normal weight patients were associated with higher mortality rates.

An attempt to reaffirm this inverse relationship between BMI and clinical outcome in this scenario, however, was not possible in many other similarly conducted trials [24, 25]. Our research working group analyzed data from 890 patients diagnosed with ST‐elevated myocardial infarction and followed them up for a duration of 12 months. This group also constituted patients diagnosed with cardiogenic shock. Interestingly, results indicated that clinical events did not vary significantly between all three weight groups, thus challenging the premise of the "obesity paradox" [26] (**Table 2**).


**Table 2.** Overview of literature addressing the "obesity paradox" in patients suffering from acute coronary syndrome, including cardiogenic shock, undergoing coronary revascularization.
