Author + information
- Received December 13, 2012
- Revision received May 17, 2013
- Accepted May 21, 2013
- Published online August 20, 2013.
- Saeed Payvar, MD, MS∗,
- Sunghee Kim, PhD†,
- Sunil V. Rao, MD†,
- Ronald Krone, MD‡,
- Megan Neely, PhD†,
- Nikhil Paladugu∗ and
- Ramesh Daggubati, MD∗∗ ()
- ∗East Carolina University Brody School of Medicine, Greenville, North Carolina
- †Washington University School of Medicine, St. Louis, Missouri
- ‡Duke Clinical Research Institute, Durham, North Carolina
Reprint requests and correspondence:
Dr. Ramesh Daggubati, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, North Carolina 27834.
Objectives The purpose of this study was to compare in-hospital outcomes of percutaneous coronary intervention (PCI) in extreme obesity (EO) (body mass index [BMI] ≥40 kg/m2) with those of normal-weight (NW) patients and to examine the influence of access site on outcomes.
Background Little is known about the outcomes of PCI in EO patients.
Methods We analyzed CathPCI Registry data from patients who underwent radial or femoral PCI and were discharged between July 2009 and June 2011 and compared in-hospital outcomes of EO (N = 83,861) with those of NW patients (BMI 20 to 25 kg/m2; N = 217,616). Outcomes included in-hospital mortality and procedural and bleeding complications. Multivariable logistic regression models were used to assess the independent association of EO with outcomes, using previously validated risk models derived from the CathPCI Registry. The role of access site was specifically examined.
Results Compared with NW patients, EO patients were younger (median age 60 vs. 69 years), more likely female (47% vs. 37%), and more likely African American (12% vs. 7%). EO patients had lower unadjusted mortality (1.2% vs. 2.0%); however, after multivariable adjustment, EO was independently associated with increased risk of in-hospital mortality (odds ratio: 1.22; 95% CI: 1.08 to 1.39) in those presenting with ST-segment elevation myocardial infarction (STEMI). Access site had no effect on bleeding or outcome.
Conclusions EO patients who underwent PCI were younger and had less bleeding compared with NW patients. After multivariable adjustment for risk, EO was independently associated with higher in-hospital mortality overall and particularly in the patients undergoing STEMI.
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR). The views expressed in this paper represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at http://www.ncdr.com. CathPCI Registry is an initiative of the American College of Cardiology Foundation and the Society for Cardiovascular Angiography and Interventions. Dr. Daggubati has received speaker fees from Medtronic, Abbott Vascular, Eli Lilly, and AstraZeneca; and consultant fees from Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 13, 2012.
- Revision received May 17, 2013.
- Accepted May 21, 2013.
- American College of Cardiology Foundation