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Extreme obesity linked to in-hospital mortality in PCI-treated patients
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A retrospective analysis of in-hospital outcomes has found that extreme obesity was associated with higher in-hospital mortality in patients presenting with STEMI who were treated with PCI.
Researchers analyzed CathPCI Registry data from patients who underwent radial or femoral PCI and were discharged between July 2009 and June 2011. They compared in-hospital outcomes of 83,861 patients with extreme obesity (BMI ≥40 kg/m2) with those of 217,616 normal-weight patients (BMI 20-25 kg/m2).
Extremely obese patients had lower unadjusted mortality than normal-weight patients (1.2% vs. 2%), as well as lower rates of bleeding, periprocedural MI, cardiogenic shock, HF and tamponade, and higher rates of renal failure and access hematoma.
After multivariable adjustment, extreme obesity was independently associated with higher mortality (OR=1.14; 95% CI, 1.04-1.25) and lower rates of bleeding (OR=0.80; 95% CI, 0.76-0.83). In those presenting with STEMI, extreme obesity was independently associated with increased risk for in-hospital mortality (OR=1.22; 95% CI, 1.08-1.39).
Researchers said those who underwent stenting procedures were younger and had less bleeding compared with normal-weight patients, which may reflect under-dosing of anticoagulants or more use of closure devices or transradial access.
They also said weight-based dosing protocols for unfractionated heparin are not affected by morbid obesity, whereas data on weight-based dosing of low–molecular-weight heparin are limited due to either under-representation or exclusion from drug trials, leading to uncertainty.
“Under-dosing of anticoagulants could be associated with increased mortality in this subgroup,” the researchers wrote. “However, it is notable that in our study, there were 4.4 bleeding complications per mortality in the extremely obese subjects vs. 3.9 in those with normal weight.”
Disclosure: The researchers report no relevant financial disclosures.
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