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Body Mass Index Is Associated With Differential Rates of Coronary Revascularization After Cardiac Catheterization
Tasuku Terada1, Jeffrey A Johnson2, Colleen Norris3
1Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
Obesity is linked to varied rates of coronary revascularization, with higher PCI use in obese patients with high-risk coronary anatomy and diabetes. Further research is needed on the appropriateness of these higher PCI rates.
Area of Science:
- Cardiology
- Obesity Medicine
- Interventional Cardiology
Background:
- The relationship between obesity and coronary revascularization procedures like CABG and PCI remains unclear.
- This study investigates revascularization rates in relation to obesity, considering coronary disease severity and diabetes.
- Understanding these associations is crucial for patient management and treatment strategies.
Purpose of the Study:
- To examine the association between different classes of obesity and the likelihood of undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- To analyze these associations within strata defined by coronary anatomy risk and diabetes status.
- To provide insights into potential disparities in cardiovascular intervention based on body mass index (BMI).
Main Methods:
- Cardiac catheterization patients were stratified by coronary anatomy risk and diabetes status.
- Body mass index (BMI) categories (normal, overweight, obese classes I-III) were compared.
- Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated for CABG and PCI likelihood.
Main Results:
- Overall revascularization was higher in overweight, obese class I, and obese class II patients compared to normal BMI.
- Obese class III patients showed lower overall revascularization rates (aHR, 0.91; 95% CI, 0.85-0.97).
- In patients with high-risk coronary anatomy and diabetes, all obese classes exhibited higher PCI rates than normal BMI individuals.
Conclusions:
- Body mass index (BMI) is associated with differential rates of coronary revascularization.
- Higher PCI rates in obese patients with high-risk coronary anatomy and diabetes require further investigation regarding clinical appropriateness.
- These findings highlight the complex interplay between obesity, cardiovascular disease, and treatment utilization.
Background:
The association of obesity with coronary revascularization procedures is not clear. We examined rates of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) associated with obesity while accounting for the severity of coronary disease and diabetes status.
Methods:
Patients who underwent cardiac catheterization were stratified according to coronary anatomy risks and diabetes status. Within each stratum, using normal body mass index (BMI) (18.5-24.9 kg/m2) as a reference, the associations of overweight (25.0-29.9 kg/m2), obese class I (30.0-34.9 kg/m2), obese class II (35.0-39.9 kg/m2), and obese class III (≥ 40.0 kg/m2) with the likelihood of receiving CABG and PCI were assessed while adjusting for clinical covariates.
Results:
Of 56,722 patients analyzed, overall use of revascularization was higher in the overweight, obese class I, and obese class II groups (overweight: adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.06-1.13; obese class I: aHR, 1.08; 95% CI, 1.05-1.12; obese class II: aHR,1.05; 95% CI, 1.01-1.10), whereas it was lower in the obese class III group (aHR, 0.91; 95% CI, 0.85-0.97) compared with normal BMI. In the subgroup with high-risk coronary anatomy and diabetes, all obese classes had higher rates of PCI (obese class I: aHR,1.24; 95% CI, 1.08-1.42; obese class II: aHR,1.27; 95% CI, 1.07-1.49, obese class III: aHR,1.37; 95% CI, 1.12-1.67) than the normal BMI group.
Conclusions:
Our results showed that BMI is associated with differential rates of coronary revascularization. In patients with high-risk coronary anatomy and diabetes, clinical appropriateness of higher rates of PCI associated with obesity warrants further investigation.
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