The Obesity Paradox in Patients Undergoing Transcatheter Aortic Valve Implantation

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Abstract
Background: Obesity is a major risk factor for cardiovascular morbidity and mortality. A considerable number of studies, however, showed better outcomes for overweight patients undergoing cardiovascular interventions—the so called obesity paradox.Hypothesis: Increased body mass index (BMI) is independently associated with improved survival following transcatheter aortic valve implantation (TAVI).Methods: We analyzed the data of 409 consecutive patients undergoing TAVI in our medical center. Patients were categorized into 4 groups according to BMI: underweight (≤18.4 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Procedure‐related complications were recorded, as well as 30‐day and 1‐year all‐cause mortality rates.Results: Obese patients had a higher prevalence of comorbidities and higher incidence of vascular complications compared with the normal‐weight patients (16% vs 7%, P = 0.013). Nevertheless, 30‐day mortality was similar among the groups, whereas 1‐year mortality was lower among the overweight and obese patients (BMI >25) (P = 0.038). After adjusting for differences in baseline characteristics, increase in BMI was found to be independently associated with improved survival following TAVI (hazard ratio: 0.94, confidence interval: 0.89‐0.99, P = 0.043).Conclusions: In our single‐center study, obesity and overweight were independently associated with better outcome, supporting the obesity paradox in the TAVI population.

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