Body mass index, periprocedural bleeding, and outcome following percutaneous coronary intervention (from the British Columbia Cardiac Registry).

The incidence of obesity is increasing throughout the industrialized world and is a major public health concern. Some studies have shown a paradoxical protective effect of moderate obesity on outcome after percutaneous coronary intervention (PCI). The association between bleeding, body mass, and outcome is not well established and formed the basis for the present study, which examined major bleeding rates and mortality after PCI in British Columbia during a 6-year period. We identified 38,346 consecutive patients from the British Columbia Cardiac Registry who underwent PCI from 1999 to 2005. Data were cross-referenced to determine outcomes at 30 days and 1 year. Information about bleeding after PCI was obtained by cross-referencing the British Columbia Cardiac Registry with the Central Transfusion Registry. Baseline patient characteristics were compared among body mass index (BMI) categories. A clear bimodal (U-shaped) relation was seen between BMI and mortality. BMI was a potent independent predictor of mortality, particularly evident in the underweight (BMI <18.5 kg/m(2); odds ratio [OR] 1.98, 95% confidence interval [CI] 1.6 to 2.5, p <0.0001) and morbidly obese (> or =40 kg/m(2); OR 1.61, 95% CI 1.28 to 2.08, p <0.0001) groups. Periprocedural transfusion was also associated with adverse outcome (OR 2.86, 95% CI 2.52 to 3.25, p <0.0001). Transfusion adopted the same bimodal distribution across the entire cohort. Emergent PCI and femoral access were procedural factors associated with outcome. In conclusion, major bleeding conferred an adverse long-term prognosis after PCI. Identifying demographic and procedural factors that increase risk will facilitate more accurate risk scoring of patients undergoing PCI and allow targeted bleeding-avoidance strategies. Body mass and female gender identified subgroups at much higher risk of bleeding after PCI, an observation that merits further study.

[1]  S. Ellis,et al.  Low-normal or excessive body mass index: newly identified and powerful risk factors for death and other complications with percutaneous coronary intervention. , 1996, The American journal of cardiology.

[2]  Sunil V. Rao,et al.  Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. , 2004, JAMA.

[3]  G. Biondi-Zoccai,et al.  Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. , 2004, Journal of the American College of Cardiology.

[4]  H. Boshuizen,et al.  Multiple imputation of missing blood pressure covariates in survival analysis. , 1999, Statistics in medicine.

[5]  T. Kinnaird,et al.  Bleeding during percutaneous intervention: tailoring the approach to minimise risk , 2008, Heart.

[6]  S. Sivasankaran,et al.  Restrictive cardiomyopathy in India: the story of a vanishing mystery , 2008, Heart.

[7]  M. Beydoun,et al.  The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. , 2007, Epidemiologic reviews.

[8]  R. Califf,et al.  Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. , 2007, European heart journal.

[9]  H. White,et al.  Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. , 2007, Journal of the American College of Cardiology.

[10]  R. Nesto,et al.  Impact of gender on in-hospital outcomes following contemporary percutaneous intervention for peripheral arterial disease. , 2005, The Journal of invasive cardiology.

[11]  A. Tremblay,et al.  Impact of Body Mass Index on Outcomes Following Critical Care. , 2003, Chest.

[12]  J D Hilton,et al.  Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg) , 2008, Heart.

[13]  M. Parikh,et al.  Impact of body mass index on in-hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry). , 2004, The American journal of cardiology.

[14]  E. Topol,et al.  Impact of body mass index on outcome after percutaneous coronary intervention (the obesity paradox). , 2002, The American journal of cardiology.

[15]  N. Weissman,et al.  Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. , 2003, The American journal of cardiology.

[16]  N. Weissman,et al.  The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? , 2002, Journal of the American College of Cardiology.

[17]  Manning Feinleib,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[18]  A. Yeung,et al.  Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices. , 2005, Journal of the American College of Cardiology.

[19]  S. Yusuf,et al.  Adverse Impact of Bleeding on Prognosis in Patients With Acute Coronary Syndromes , 2006, Circulation.

[20]  C. Rogers,et al.  Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients. , 2004, The American journal of cardiology.

[21]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[22]  M. Bell,et al.  Association of body mass index with outcome after percutaneous coronary intervention. , 2003, The American journal of cardiology.

[23]  T. Mihaljevic,et al.  Duration of red-cell storage and complications after cardiac surgery. , 2008, The New England journal of medicine.

[24]  H. Gurm,et al.  The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). , 2002, Journal of the American College of Cardiology.

[25]  A. Jacobs,et al.  Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention: Data from the National Heart, Lung, and Blood Institute Dynamic Registry , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.