Abstract 17884: Coronary Angiography in Patients with a BMI Over 40: A Preliminary Assessment of the Efficacy and Safety of the Radial Artery Approach
Clinical assessment of obese patients with chest pain and/or dyspnea is often suboptimal due to the reduced specificity and sensitivity of non-invasive assessment modalities. Invasive imaging (i.e., coronary angiography) has historically been avoided due to the increased risk of vascular access complications via the traditional femoral artery approach and poor image quality due to reduced body mass penetration. However, with improvements in imaging technology and the use of the radial artery for vascular access coronary angiography may be an important and relatively under-used diagnostic (and therapeutic) option for obese patients.
Purpose: To perform a preliminary assessment of the feasibility and safety of the radial artery approach for coronary angiography in morbidly obese patients. From 2000-2007 forty-eight patients with a BMI>40 were identified at our institution. Patient demographics included: mean age of 54 +/- 1 years; 50% males, mean BMI of 46.1 +/- 0.8 (range: 40.1 - 63.1; median 44.7). Sixteen (33%) patients had a diagnosis of an acute coronary syndrome, while the remainder had stable angina or high-risk non-invasive testing. Mean procedure time was 83 +/- 5 minutes. Eight (17%) patients had no significant epicardial stenoses (“normal”). Fourteen (29%) patients had CAD that was deemed suitable for medical Rx. Twenty two (46%) patients underwent PCI (1-5 stents; median 2). Four patients underwent elective CABG. Coronary angiography was successfully performed without event in 98% of patients (1 dissection that was stented). No bleeding incidents occurred. Length of hospital stay post index cath was 2.3 +/- 1.3 days (median 1.0 days). During follow up (16 +/- 3 months) 3 patients died: one due to respiratory failure related to interstitial lung disease (patient had normal coronary arteries), one sudden death cause uncertain and one from congestive heart failure (CAD deemed non-revascularizable).
Conclusions: Morbidly obese patients can safely and efficaciously undergo invasive coronary angiography and stenting via the radial artery approach. Further assessment of this invasive strategy may prompt a change in practice patterns for managing patients with a large body habitus who are often incompletely assessed and managed.
- © 2010 by American Heart Association, Inc.