May 10, 2026Journal of the American College of Cardiology
The Burgeoning Epidemic of Morbid Obesity in Patients Undergoing Percutaneous Coronary Intervention
Key result
Morbid obesity linked to ~31% higher vascular complication risk after PCI vs. overweight patients.
- adjusted OR 1.31
- 95% CI 1.17 to 1.47
- P<0.0001
- n=227,044
Why the study?
There is a paucity of contemporary data on the prevalence and clinical implications of morbid obesity among patients undergoing PCI.
Does morbid obesity increase the risk of mortality and morbidity in patients undergoing PCI compared to overweight patients?
Key Points
- To examine secular trends in the prevalence of morbid obesity and assess its impact on clinical outcomes and complications following percutaneous coronary intervention.
- Analyzed multicenter registry data from 227,044 patients undergoing percutaneous coronary intervention in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium between 1998 and 2009.
- Compared procedural outcomes between patients with morbid obesity (body mass index ≥ 40 kg/m²) and overweight controls (body mass index 25 to 30 kg/m²).
- The prevalence of morbid obesity among patients undergoing percutaneous coronary intervention nearly doubled, rising from 4.38% in 1998 to 8.36% in 2009.
- Morbid obesity was associated with significantly increased odds of vascular complications (adjusted OR: 1.31; 95% CI: 1.17 to 1.47; p < 0.0001) and in-hospital mortality (adjusted OR: 1.63; 95% CI: 1.33 to 2.00; p < 0.0001).
- Morbidly obese patients experienced higher rates of contrast-induced nephropathy (adjusted OR: 1.89; 95% CI: 1.70 to 2.11; p < 0.0001) and nephropathy requiring dialysis (adjusted OR: 4.08; 95% CI: 2.98 to 5.59; p < 0.0001).
Study Design
Type
Cohort (n=227,044)
Multicenter
Yes
Structured PICO
Does morbid obesity increase the risk of mortality and morbidity in patients undergoing PCI compared to overweight patients?
P
Population
227,044 patients undergoing percutaneous coronary intervention enrolled in a Michigan registry between 1998 and 2009.
E
Exposure
Morbid obesity (body mass index [BMI] ≥ 40 kg/m²)
C
Comparator
Overweight patients (BMI 25 to 30 kg/m²)
O
Outcome
Mortality, vascular complications, contrast-induced nephropathy, and nephropathy requiring dialysishard clinical
Main Result
Odds Ratio: 1.31 (95% CI 1.17–1.47)
p-value: p=< 0.0001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“much has been written in recent years about the so-called 'obesity paradox,' which suggests that obese patients with cardiovascular disease have a better prognosis than their lean counterparts”
Implication
Morbid obesity is increasingly prevalent among patients undergoing PCI and is associated with significantly higher risks of mortality, vascular complications, and nephropathy compared to being overweight.
Abstract
OBJECTIVES: This study sought to examine the prevalence and clinical implications of morbid obesity among patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: The prevalence of obesity, and morbid obesity in particular, continues to rise rapidly in the United States. Obese patients are at increased risk for cardiac disease and are more likely to need invasive cardiac procedures. There is a paucity of contemporary data on the prevalence and clinical implications of morbid obesity among patients undergoing PCI. METHODS: We examined the prevalence of morbid obesity (body mass index [BMI] ≥ 40 kg/m²) among 227,044 patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry from 1998 to 2009. RESULTS: The proportion of morbidly obese patients undergoing PCI increased from 4.38% in 1998 to 8.36% in 2009. Compared with overweight patients (BMI 25 to 30 kg/m²), these patients had significantly increased vascular complications (adjusted odds ratio [OR]: 1.31; 95% CI: 1.17 to 1.47; p < 0.0001), contrast-induced nephropathy (adjusted OR: 1.89; 95% CI: 1.70 to 2.11; p < 0.0001), nephropathy requiring dialysis (adjusted OR: 4.08; 95% CI: 2.98 to 5.59; p < 0.0001), and mortality (adjusted OR: 1.63; 95% CI: 1.33 to 2.00; p < 0.0001). CONCLUSIONS: Morbid obesity is increasing in prevalence among patients undergoing PCI and is associated with a higher risk of mortality and morbidity. These epidemiological changes have important implications for technical considerations of cardiac catheterization, design of the catheterization lab to accommodate these patients, and most importantly, for societal effort toward prevention of obesity.
Discussion
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Cite This Study
Buschur et al. (2013) conducted a cohort in Patients undergoing percutaneous coronary intervention (PCI) (n=227,044). Morbid obesity (BMI ≥ 40 kg/m²) vs. Overweight patients (BMI 25 to 30 kg/m²) was evaluated on vascular complications (adjusted OR 1.31, 95% CI 1.17 to 1.47, p=< 0.0001). Morbid obesity in patients undergoing PCI was associated with increased vascular complications (OR 1.31; 95% CI 1.17-1.47) and mortality (OR 1.63; 95% CI 1.33-2.00) compared to overweight patients.