Study Shows Morbidly Obese Patients Undergoing PCI Have Poorer Outcomes

Over the last decade, the proportion of patients undergoing percutaneous coronary intervention (PCI) who are morbidly obese (body mass index [BMI] ≥40 kg/m2) has increased, and these patients suffer a higher risk of morbidity and mortality than their lighter weight counterparts. These findings were published Aug. 12 in the Journal of the American College of Cardiology.

“This study opens up the opportunity for additional studies. We need to learn more about how nephropathy seems to be worse in obese patients. We need to be sure that we know whether femoral access or radial access is the better approach,” said Peter Block, MD, FACC.

Investigators looked at 227,044 patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry between 1998 and 2009. The proportion of morbidly obese patients undergoing PCI increased from 4.38 percent in 1998 to 8.36 percent in 2009. As compared to overweight patients (BMI 25 to 30 mg/m2), morbidly obese patients suffered significantly higher rates of vascular complications, contrast-induced nephropathy, nephropathy requiring dialysis and death, despite being younger and having a lower incidence of acute myocardial infarction, cardiogenic shock and a lesser need for emergent intervention.

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These findings have “important implications for technical considerations of cardiac catheterization and design of the catheterization laboratory to accommodate these patients. The need to deal with increasing body weight will require catheterization tables with greater weight tolerance and systems to safely transfer patients to and from these tables. Further, better radiation shielding and consideration of alternative imaging strategies need to be considered because these patients and their physicians are exposed to increased radiation,” wrote the investigators.

In addition to these technical considerations, the investigators conclude, “the dramatic increase in the proportion of young patients with morbid obesity invokes the need for more upstream interventions for primary prevention and better treatment of obesity.”

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Acute Heart Failure

Keywords: Renal Dialysis, Shock, Cardiogenic, Body Mass Index, Overweight, Obesity, Morbid, Cardiac Catheterization, Body Weight, Blue Cross Blue Shield Insurance Plans, Primary Prevention, United States, Percutaneous Coronary Intervention

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