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While some studies suggested a benefit of an increased body mass index (BMI) in terms of MVO occurrence in ST-elevation myocardial infarction (STEMI), there are currently no data available on the influence of overweight on the development of MVO in Non-STEMI (NSTEMI). Thus, the aim of this study was to assess the association between MVO and BMI in NSTEMI patients. This study investigated a sub-cohort of the TATORT-NSTEMI trial. Overall, 354 patients were included with a median age of 68 years (25% women). Cardiac magnetic resonance imaging (CMR) was performed within four days after the index event. MVO was defined as hypointense core within the infarcted area in late-enhancement sequences. MVO occurred in 97 patients (27%) and patients with MVO had a significantly higher BMI (28.4\u00a0kg\/m\u00b2, interquartile range (IQR) 26.1\u201331.1 vs. 27.3\u00a0kg\/m\u00b2, IQR 24.8\u201330.3,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.024). Dichotomized at 25.6\u00a0kg\/m\u00b2 (Youden-index), patients with a BMI above that threshold showed significantly more often MVO (33% vs. 15%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In logistic regression analysis, BMI\u2009&gt;\u200925.6\u00a0kg\/m\u00b2 was a significant predictor of MVO, independent of traditional cardiovascular risk factors. In the current study, an increased BMI has been associated with MVO after NSTEMI. Further, overweight and especially a BMI above 25.6\u00a0kg\/m\u00b2 were independent predictors of MVO in these patients, challenging the so-called \u201cobesity paradox\u201d. Lastly, further research on the connection between body weight and microvascular damage in myocardial infarction is needed.\n                  <\/jats:p>","DOI":"10.1007\/s10554-026-03606-y","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T01:01:38Z","timestamp":1768784498000},"page":"639-647","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Overweight predisposes to microvascular obstruction: insights from the TATORT-NSTEMI trial"],"prefix":"10.1007","volume":"42","author":[{"given":"Felix","family":"Troger","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Eitel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roza","family":"Saraei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Stiermaier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernward","family":"Lauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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