In-hospital outcomes of percutaneous coronary interventions in extremely obese and normal-weight patients: findings from the NCDR (National Cardiovascular Data Registry).
OBJECTIVE
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.
East Carolina University Brody School of Medicine, Greenville, North Carolina, USA.
Saeed
S
Payvar
Sunghee
S
Kim
Sunil V
SV
Rao
Ronald
R
Krone
Megan
M
Neely
Nikhil
N
Paladugu
Ramesh
R
Daggubati
D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D056865:Ideal Body Weight; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000401:mortality*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
BMI; EO; NW; PCI; ST-segment elevation myocardial infarction; STEMI; body mass index; extreme obesity; extreme obesity/extremely obese; normal weight; outcomes; percutaneous coronary intervention