The burgeoning epidemic of morbid obesity in patients undergoing percutaneous coronary intervention: insight from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
OBJECTIVE
This study sought to examine the prevalence and clinical implications of morbid obesity among patients undergoing percutaneous coronary intervention (PCI).


BACKGROUND
The prevalence of obesity, and morbid obesity in particular, continues to rise rapidly in the United States. Obese patients are at increased risk for cardiac disease and are more likely to need invasive cardiac procedures. There is a paucity of contemporary data on the prevalence and clinical implications of morbid obesity among patients undergoing PCI.


METHODS
We examined the prevalence of morbid obesity (body mass index [BMI] ≥ 40 kg/m²) among 227,044 patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry from 1998 to 2009.


RESULTS
The proportion of morbidly obese patients undergoing PCI increased from 4.38% in 1998 to 8.36% in 2009. Compared with overweight patients (BMI 25 to 30 kg/m²), these patients had significantly increased vascular complications (adjusted odds ratio [OR]: 1.31; 95% CI: 1.17 to 1.47; p < 0.0001), contrast-induced nephropathy (adjusted OR: 1.89; 95% CI: 1.70 to 2.11; p < 0.0001), nephropathy requiring dialysis (adjusted OR: 4.08; 95% CI: 2.98 to 5.59; p < 0.0001), and mortality (adjusted OR: 1.63; 95% CI: 1.33 to 2.00; p < 0.0001).


CONCLUSIONS
Morbid obesity is increasing in prevalence among patients undergoing PCI and is associated with a higher risk of mortality and morbidity. These epidemiological changes have important implications for technical considerations of cardiac catheterization, design of the catheterization lab to accommodate these patients, and most importantly, for societal effort toward prevention of obesity.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Michael E
ME
Buschur
Dean
D
Smith
David
D
Share
William
W
Campbell
Stephen
S
Mattichak
Manoj
M
Sharma
Hitinder S
HS
Gurm
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000453:epidemiology* / Q000628:therapy*; D058872:Epidemics; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D012042:Registries; D014481:United States / Q000453:epidemiology
BMI; CABG; CIN; MI; NRD; PCI; body mass index; contrast-induced nephropathy; coronary artery bypass grafting; myocardial infarction; nephropathy requiring dialysis; percutaneous coronary intervention