The Burgeoning Epidemic of Morbid Obesity in Patients Undergoing Percutaneous Coronary Intervention: Insight From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Study Questions:

What are the prevalence and clinical implications of morbid obesity among patients undergoing percutaneous coronary intervention (PCI)?

Methods:

The investigators examined the prevalence of morbid obesity (body mass index [BMI] ≥40 kg/m2) among 227,044 patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry from 1998 to 2009. The authors used multiple hierarchical models to assess the impact of BMI categories on different outcomes of interest using overweight patients (the group that has traditionally demonstrated the best post-PCI outcomes) as the reference.

Results:

The proportion of morbidly obese patients undergoing PCI increased from 4.38% in 1998 to 8.36% in 2009. Compared with overweight patients (BMI 25-30 kg/m2), these patients had significantly increased vascular complications (adjusted odds ratio [OR], 1.31; 95% confidence interval [CI], 1.17-1.47; p < 0.0001), contrast-induced nephropathy (adjusted OR, 1.89; 95% CI, 1.70-2.11; p < 0.0001), nephropathy requiring dialysis (adjusted OR, 4.08; 95% CI, 2.98-5.59; p < 0.0001), and mortality (adjusted OR, 1.63; 95% CI, 1.33-2.00; p < 0.0001).

Conclusions:

The authors concluded that morbid obesity is increasing in prevalence among patients undergoing PCI, and is associated with a higher risk of mortality and morbidity.

Perspective:

The primary finding of this study is that there has been a significant increase in the proportion of morbidly obese patients undergoing PCI. Second, it appears that these patients have a markedly increased adjusted risk of complications, suggesting that the obesity paradox may not appear to be protective in this population. These epidemiological shifts have important implications for technical considerations of cardiac catheterization including access sites, design of the catheterization laboratory, and cath lab tables to accommodate these patients. There needs to be a concerted societal effort toward prevention of obesity, and the recent designation of obesity as a disease by the American Medical Association should help focus our attention on this important health problem.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Prevalence, Michigan, Kidney Diseases, Body Mass Index, Overweight, Obesity, Angioplasty, Epidemics, Percutaneous Coronary Intervention


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