PCI safe for obese patients, but may introduce increasing radiation doses
Percutaneous coronary intervention (PCI) is a safe procedure to perform on obese and morbidly obese patients, a recent study has shown.
Researchers accessed the medical records of 1,082 patients who underwent PCI, of whom 688 were nonobese (NO; body mass index [BMI] <30; median age 67 years; 75.6 percent male), 354 were obese (O; median age 65.5 years; 75.4 percent male) and 40 were morbidly obese (MO; median age 62.5 years; 57.5 percent male).
Study outcomes included in-hospital major adverse cardiovascular or cerebrovascular events (MACCE), acute kidney injury (AKI) and bleeding events.
Relative to NO patients, O and MO patients showed the same incidence rates of MACCE (1.2 percent vs 0.8 percent vs 2.5 percent), AKI (1.6 percent vs 1.1 percent vs 0.0 percent), any bleeding (16.1 percent vs 13.3 percent vs 15.4 percent) and major bleeding events (0.8 percent vs 0.8 percent vs 0.0 percent).
On the other hand, contrast usage was higher in O and MO than NO patients (190 vs 200 vs 180 mL; p=0.016), as was the median fluoroscopic dose area product (DAP; 116.4 vs 125.62 vs 75.56 Gycm2; p=0.0001) and median entrance air kerma (EAK; 2,111.63 vs 2,376.0 vs 1,439.42 mGy; p=0.0001).
Multiple linear and regression analyses showed that increasing contrast usage, fluoroscopic DAP and EAK remained significantly correlated with increasing BMI (p<0.0001 for all).
“With increasing obesity, patients undergoing PCI are exposed to increasing doses of radiation. This increases the risk of skin effects for both obese and morbidly obese patients and increases the risk of late effects of radiation in obese patients,” said researchers.