title: Clinical outcomes among patients with extreme obesity undergoing elective coronary revascularization: Evaluation of major complications in contemporary practice.
abstract: OBJECTIVE
  Individuals with extreme obesity (EO), defined by a body mass index (BMI) ≥ 40 kg/m(2), constitute an increasingly prevalent population at higher risk of procedural complications. The implications of increasing weight burdens among this subset of patients in the setting of elective coronary revascularization have yet to be adequately studied.
  
  
  METHODS
  We sought to define major complications in this group at one year following contemporary revascularization strategies by retrospectively analysing a cohort of consecutive EO patients undergoing elective percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The primary endpoint was a composite of peri- and post-procedural complications. Secondary endpoints included a cardiovascular composite and target vessel revascularization (TVR).
  
  
  RESULTS
  Adjusted event-free survival curves for the primary endpoint among 133 patients differed significantly with higher BMI (>43.2 kg/m(2)) associated with greater risk (p=0.02). The primary endpoint occurred more frequently with CABG compared to PCI (24.2% vs. 5.0%, p < 0.01), which remained significant after adjusting for differences in baseline variables. Rates of the cardiovascular composite and TVR were comparable.
  
  
  CONCLUSIONS
  Increasing BMI was associated with greater risk for major complications among EO patients undergoing elective coronary revascularization. PCI was associated with fewer complications; however, both revascularization strategies demonstrated equivalent rates of death, MI, and/or stroke. Larger studies may permit a better understanding of the associations between increasing BMI and specific outcomes and to evaluate the role for pre-procedural weight loss in this select population.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Ramirez
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Trevor
authors.initials: T
authors.lastname: Simard
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Ronnen
authors.initials: R
authors.lastname: Maze
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Pourdjabbar
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Aun-Yeong
authors.initials: AY
authors.lastname: Chong
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Le May
authors.affiliation: The Weight Management Clinic, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Shiau
authors.affiliation: Department of Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada.
authors.forename: Kumanan R
authors.initials: KR
authors.lastname: Wilson
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Hawken
authors.affiliation: Division of Cardiology, Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada.
authors.forename: Edward R
authors.initials: ER
authors.lastname: O'Brien
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada. Electronic address: dso@ottawaheart.ca.
authors.forename: Derek Y
authors.initials: DY
authors.lastname: So
mesh_terms: D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications*; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Body mass index; CABG; Coronary artery disease; Obesity; PCI