Obese patients undergoing CTO-PCI had longer procedures (+16 min), higher contrast doses (+62 mL), more radiation (+12 min), and 12.5% complication rate vs 2.6% in non-obese.
Does obesity worsen procedural and long-term clinical outcomes in patients undergoing successful CTO-PCI?
Obesity is associated with increased procedural complexity and periprocedural complications during CTO-PCI, but long-term clinical outcomes remain comparable to those of non-obese patients.
Abstract Introduction Obesity is an established cardiovascular risk factor, heightening the risk of coronary artery disease and adverse cardiovascular events. The influence of obesity on procedural and long-term outcomes after successful chronic coronary total occlusion (CTO) recanalization remains sparse. Methods Single-center, retrospective study. Patients undergoing CTO percutaneous coronary intervention (PCI) from 2017 to 2023 were included. We aimed to assess the procedural and long-term clinical outcomes following successful CTO-PCI in patients with and without obesity (body mass index≥30 kg/m2). Statistical analysis was performed using SPSS 28.0.1.1 software. Results A total of 118 patients were included (40 obese vs. 78 non-obese). The mean age of the population was 66.1(±9.9) years, 80.5% men. More males were in the obesity group (70.4% vs. 92.5%, p=0.019). The right coronary artery was most affected (44.1%), with 83.3% of CTOs showing Rentrop 3. Regarding the technical procedure, a retrograde approach was needed in 13.5% of patients, and femoral vascular access was used in 51.7%, with no significant difference between both groups (p=0.743 and p=0.607, respectively). Conversely, significant differences were found in procedural time (59 vs. 75min, p=0.026), contrast dose (223 vs. 285 mL, p=0.007), and radiation exposure time (28 vs. 40min, p=0.036) between both groups, with significantly higher values noticed in the obese group. Similarly, crossing difficulties were significantly more prevalent in obese patients (53.8% vs. 72.5%, p=0.050). Procedural complications occurred in 5.9% of cases, including distal vessel dissections (n=4), proximal dissections (n=2), and one case of acute limb ischemia, with a considerably higher complications rate in obese patients (2.6% vs. 12.5%, p=0.044). The mean follow-up was 47(±21) months, similar in both groups (p=0.131). A significant increase in mean ejection fraction (EF) was observed after CTO recanalization (47.5% vs. 51.5%; p=0.001), which persisted in the non-obese group (p=0.005), but not in the obese group (p=0.097). No in-hospital deaths were recorded. The all-cause mortality rate during the longest follow-up was similar in the obese (7.5%) and non-obese (7.7%) patients (p=1.000). Although the obese group showed a slightly higher rate of repeated revascularization (7.4%) compared to the non-obese (6.3%), this difference was not statistically significant (p=1.000). Conclusions Although obese patients with successful CTO revascularization achieve comparable long-term outcomes to non-obese patients, our study suggests that this group faces higher risks of periprocedural complications, technical difficulties, and longer procedural duration. These findings emphasize the elevated risk profile within this demographic and the need for tailored strategies in managing CTO patients with obesity.
Silva et al. (2025) studied this question. Obese patients undergoing CTO-PCI had longer procedures (+16 min), higher contrast doses (+62 mL), more radiation (+12 min), and 12.5% complication rate vs 2.6% in non-obese.