F Daniel Ramirez1, Benjamin Hibbert1, Trevor Simard1, Ronnen Maze1, Ali Pourdjabbar1, Aun-Yeong Chong1, Michel Le May1, Judy Shiau2, Kumanan R Wilson3, Steven Hawken4, Edward R O'Brien5, Derek Y So6. 1. Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada. 2. The Weight Management Clinic, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada. 3. Department of Medicine, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. 4. Institute for Clinical Evaluative Sciences, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada. 5. Division of Cardiology, Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada. 6. Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada. Electronic address: dso@ottawaheart.ca.
Abstract
BACKGROUND/ OBJECTIVES: 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.
BACKGROUND/ OBJECTIVES: 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: Katja Buschmann; Julius Wrobel; Ryan Chaban; Romina Rösch; Ahmed Ghazy; Alina Hanf; Katrin Schäfer; Andreas Daiber; Andres Beiras-Fernandez; Christian Friedrich Vahl Journal: Oxid Med Cell Longev Date: 2020-06-23 Impact factor: 6.543