The Burgeoning Epidemic of Morbid Obesity in Patients Undergoing Percutaneous Coronary Intervention

Lester

Cardiology Research and Practice

et al. 2016

Background and Aim. Obesity (BMI ≥ 30 kg/m2) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL. Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (n = 1073); overweight, 25.0 ≤ BMI < 30 (n = 2608); and obese, BMI ≥ 30.0 (n = 2792). Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%, p = 0.001). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%, p = 0.386) or postprocedural (1.0%, 0.8%, and 0.9%, p = 0.725) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes. Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI.

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada

Lester

Cardiology Research and Practice

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

“…It is expected that an increasing number of obese patients will require cardiac surgery. 4 While not always accurate, BMI is still a useful measure of overall body habitus since it is highly correlated with body surface area (BSA); 5 it is also commonly used in anthropometric measurements in most previous and new risk models for the Society of Thoracic Surgeons (STS). 5-7 …”

mentioning

confidence: 99%

Impact of Body Mass Index on Outcomes in Cardiac Surgery

Gao

Sun

Young³

et al. 2016

Objectives Body mass index (BMI) is commonly used in obesity classification as a surrogate measure and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate BMI on short-term outcomes after cardiac surgery. Design A retrospective cohort study. Setting University teaching hospital, two centers. Participants The study consisted of 4,740 patients who underwent cardiac surgery of two hospitals from July 1, 2001 to June 30, 2013 in one hospital and from September 1, 2003 to August 31, 2014 in another hospital were included in this study. Interventions No changes to standard practice were required. Measurements and Main Results They were assigned into six BMI groups as follows: Underweight BMI < 18.5 kg/m2), Normal weight (18.5 ≤ BMI < 25 kg/m2), Overweight (25 ≤ BMI < 30 kg/m2), Class I (30 ≤ BMI < 35 kg/m2), Class II (35 ≤ BMI < 40 kg/m2) and Class III obese (BMI ≥ 40 kg/m2). Short-term major postoperative complications (post-operative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, ICU readmission, total ICU hours and readmission in 30 days) and mortalities (in-hospital mortality, 30-day mortality, operative mortality) were compared among various BMI groups after cardiac surgery. Age, gender, surgery type, family history of CAD, diabetes, hypertension, heart failure and lipid lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that being Underweight or Class III obese may present with significant differences of some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter and renal failure. However, being Overweight or Class I obese has a positive impact on discharge mortality and operative mortality. Conclusions The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an “obese paradox” in short-term mortality after cardiac surgery.

“…We also showed a higher incidence of CI-AKI in obese patients, based on the reverse J-curve relationship between BMI and CI-AKI incidence. Buschur et al [ 39 ] found that poor fluoroscopic visualization and miscalculation of renal function is common in obese patients. We believe that a vulnerability to contrast media and an erroneous estimation of renal function are responsible for this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention

et al. 2018

BackgroundLimiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus.ObjectiveWe aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs).MethodsWe evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI.ResultsA V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42–2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22–2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05–1.10]; P < 0.001).ConclusionsA V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.