The Burgeoning Epidemic of Obesity in Patients Undergoing Percutaneous Coronary Intervention (Pci): Insight From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (Bmc2)

Buschur, Michael; Smith, Dean E.; Moscucci, Mauro; Share, David; Campbell, William

doi:10.1016/s0735-1097(12)60055-2

Cited by 10 publications

(12 citation statements)

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“…This finding was similar to the finding from the study by Kuduvalli et al involving 4,713 patients that demonstrated obesity as a risk factor for atrial arrhythmia.…”

Section: Impact Of Body Mass Indexsupporting

confidence: 92%

“…It is expected that an increasing number of obese patients will require cardiac surgery. 4 Even though not always accurate, BMI still is a useful measure of overall body habitus because it is highly correlated with body surface area 5 ; it also commonly is used in anthropometric measurements in most previous and new risk models for the Society of Thoracic Surgeons (STS). [5][6][7] Several studies have examined the effects of obesity on inhospital mortality and long-term survival with variable conclusions.…”

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confidence: 99%

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Impact of Body Mass Index on Outcomes in Cardiac Surgery

Gao¹,

Sun²,

Young³

et al. 2017

Survey of Anesthesiology

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Objectives: Body mass index (BMI) commonly is 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 the impact of BMI on short-term outcomes after cardiac surgery.Design: A retrospective cohort study. Setting: University teaching hospital, 2 centers. Participants: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from Interventions: No changes to standard practice were required.Measurements and Main Results: Patients were assigned into 6 BMI groups as follows: underweight (BMI o18.5 kg/ m 2 ), normal weight (Z18.5 to o25 kg/m 2 ), overweight (Z25 to o30 kg/m 2 ), class I obese (Z30 to o35 kg/m 2 ), class II obese (Z35 to o40 kg/m 2 ), and class III obese (BMI Z40 kg/ m 2 ). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some shortterm outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical 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.

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“…This finding was similar to the finding from the study by Kuduvalli et al involving 4,713 patients that demonstrated obesity as a risk factor for atrial arrhythmia.…”

Section: Impact Of Body Mass Indexsupporting

confidence: 92%

mentioning

confidence: 99%

Impact of Body Mass Index on Outcomes in Cardiac Surgery

Gao¹,

Sun²,

Young³

et al. 2017

Survey of Anesthesiology

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“…Die Koronarangiographie stellt den Goldstandard zur Abklärung einer KHK dar [18]. Eine neuere Auswertung zeigt aber, dass die Untersuchung bei morbider Adipositas mit einem erhöhten Risiko für vaskuläre und kontrastmittelabhängige Komplikationen verbunden ist und zudem eine erhöhte Mortalität aufweist [4]. Ein Zugang über die A. radialis sollte erwogen werden.…”

Section: Kardiale Diagnostik Bei Adipositasunclassified

Adipositas und Herzinsuffizienz

Weismann

Wiedmann²,

Bala

et al. 2015

Internist

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“…Bleeding and vascular complications after cardiac catheterization and PCI remain a common and important concern and are strongly associated with worse clinical outcomes [8,9]. It has been previously demonstrated that both morbid obesity and lean body mass index (BMI) are associated with a higher risk for vascular complications and requirement for transfusion after PCI [10]. It is not known whether BMI predicts which patients might benefit from TRA, compared with femoral approach for PCI.…”

Section: Introductionmentioning

confidence: 99%

Does Radial Pci Negate the Obesity Paradox? Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

McDonagh

Dixon

LaLonde

et al. 2014

Journal of the American College of Cardiology

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Objective: To examine if transradial approach (TRA) negates the increased risk associated with femoral access in lean and morbidly obese patients undergoing percutaneous coronary intervention (PCI). Background: Patients at extremes of body mass are at increased risk of bleeding after PCI. TRA has been associated with lower overall rates of bleeding compared to femoral approach. Methods and Results: We studied patients undergoing emergent and elective PCI from 2010 to 2012 across 47 hospitals in Michigan who participate in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry. The primary outcomes were the incidences of bleeding and postprocedure transfusion. Propensity matching (PM) was used to adjust for nonrandomized use of TRA. TRA was used in 10,235 procedures. In PM analyses, use of TRA was associated with a reduction in bleeding (0.80 vs. 1.9%, odds ratio [OR] 5 0.41, 95% confidence interval [CI] 5 0.32-0.54, P < 0.001) and need for transfusion (1.4 vs. 2.5%, OR 5 0.56, 95% CI 5 0.45-0.69, P < 0.001) compared with femoral access. The absolute difference in bleeding and transfusion associated with TRA was largest in patients with lean body mass (BMI < 25 kg/m 2 ) and morbid obesity (BMI ! 40 kg/m 2 ): Lean patients undergoing TRA had a rate of bleeding of 1.2 versus 2.8% for femoral access (OR 5 0.43, 95% CI 5 0.24-0.77, P 5 0.002); and rate of transfusion of 2.4 versus 3.9% (OR 5 0.61, 95% CI 5 0.40-0.94, P 5 0.019). The morbidly obese had a rate of bleeding of 0.8% for TRA versus 2.4% for femoral access (OR 5 0.33, 95% CI 5 0.44-0.72, P 5 0.004); and rate of transfusion of 1.7 versus 3.0%, (OR 5 0.55, 95% CI 5 0.30-1.0, P 5 0.051). Conclusions: Compared with the femoral approach, TRA is associated with a reduction in bleeding across all patients undergoing PCI and the absolute benefit was greatest in those with extremely low or high BMI. V C 2015 Wiley Periodicals, Inc.

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The Burgeoning Epidemic of Obesity in Patients Undergoing Percutaneous Coronary Intervention (Pci): Insight From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (Bmc2)

Cited by 10 publications

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Impact of Body Mass Index on Outcomes in Cardiac Surgery

Impact of Body Mass Index on Outcomes in Cardiac Surgery

Adipositas und Herzinsuffizienz

Does Radial Pci Negate the Obesity Paradox? Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

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