Cardiac catheterization in morbidly obese patients.
The safety and findings of cardiac catheterization and coronary angiography in morbidly obese patients with suspected coronary heart disease (CHD) have not been fully examined in the modern era. From a database of 4,978 patients undergoing diagnostic cardiac catheterization, we identified 110 with morbid obesity (body mass > or = 145 kg and body mass index > or = 40 kg/m(2)). Relative to all the other patients in this database, morbidly obese patients had a lower prevalence of CHD (45% vs. 72%; P < 0.05), reflecting a higher prevalence of false positive noninvasive tests. Overall, noninvasive tests were only 75% sensitive and 39% specific for CHD in this group. Use of radial access (66%) and femoral closure devices (24%) was much more frequent in the morbidly obese cohort. Complications were no more frequent in the morbidly obese group, with major (0 vs. 0.9%) and minor (4.7% vs. 3.5%) adverse outcomes being similar to the rest of the database. We conclude that cardiac catheterization using the radial artery or a femoral closure device is a safe and effective method of evaluating CHD in morbidly obese patients. In contrast, noninvasive testing is frequently not definitive and may be misleading.
Section of Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA. pmcnulty@psu.edu
Patrick H
PH
McNulty
Steven M
SM
Ettinger
John M
JM
Field
Ian C
IC
Gilchrist
Mark
M
Kozak
Charles E
CE
Chambers
Joseph A
JA
Gascho
D006328:Cardiac Catheterization; D015897:Comorbidity; D000075202:Contraindications; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D025401:Echocardiography, Stress; D005080:Exercise Test; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011877:Radionuclide Imaging; D012189:Retrospective Studies