Rationale: The prevalence of obesity constantly increasing and epidemiological studies have consistently demonstrated that increased BMI is associated with a progressive rise in the risk of major adverse cardiovascular events (MACE), coronary artery disease (CAD), heart failure, and cardiovascular mortality.

Objectives: The aim of this retrospective study is to evaluate the prevalence and clinical characteristics of obesity in a cohort of patients undergoing percutaneous coronary intervention (PCI), including both acute coronary syndromes and chronic coronary disease presentations. In addition, we sought to explore the relationship between BMI and systemic inflammation and to identify clinical variables independently associated with obesity within this contemporary real-world population.

Findings: Between 2021 and 2023, a total of 2,423 patients underwent percutaneous coronary intervention (PCI) at Mauriziano Hospital in Turin. Among them, 288 patients (11.9%) had a body mass index (BMI) > 30 kg/m². A high prevalence of most common cardiovascular risk factors was observed. The most frequent indication for coronary angiography was NSTEMI (non ST elevation myocardial infarction).

Despite the high cardiovascular risk, a large proportion of patients failed to achieve guideline-recommended lipid and glycemic targets. This finding highlights a persistent gap between evidence-based recommendations and real-world clinical practice.

Moreover, elevated CRP (C reactive protein) levels have been independently associated with adverse cardiovascular outcomes and may represent an important component of residual inflammatory risk in patients with coronary artery disease.

Conclusion: Among obese patients undergoing PCI, achievement of recommended LDL-C and glycemic targets remains suboptimal. BMI is independently associated with higher CRP levels, supporting the presence of an obesity-related inflammatory phenotype. These findings underscore the need of a multidisciplinary approach to these patients.