title: Effect of body mass index on short- and long-term outcomes after transcatheter aortic valve implantation.
abstract: Better outcomes have been reported after percutaneous cardiac intervention in obese patients ("obesity paradox"). However, limited information is available on the effect of the body mass index on the outcomes after transcatheter aortic valve implantation (TAVI). We, therefore, sought to determine the effect of the body mass index on the short- and long-term outcomes in patients who underwent TAVI. The population consisted of 940 patients, of whom 25 (2.7%) were underweight, 384 had a (40.9%) normal weight, 372 (39.6%) were overweight, and 159 (16.9%) were obese. Overall, the obese patients were younger (79.7 ± 6.4 years vs 81.7 ± 7.3 and 80.8 ± 7.0 years, p = 0.008) and had a greater prevalence of preserved left ventricular and renal function. On univariate analysis, obese patients had a greater incidence of minor stroke (1.3% vs 0 and 0.3%, p = 0.03), minor vascular complications (15.7% vs 9.1% and 11.6%, p = 0.028) and acute kidney injury stage I (23.3% vs 10.7% and 16.1%, p <0.001). After adjustment, body mass index, as a continuous variable, was associated with a lower risk of mortality at 30 days (odds ratio 0.93, 95% confidence interval 0.86 to 0.98, p = 0.023) and no effect on survival after discharge (hazard ratio 1.01, 95% confidence interval 0.96 to 1.07, p = 0.73). In conclusion, obesity was associated with a greater incidence of minor, but no major, perioperative complications after TAVI. After adjustment, obesity was associated with a lower risk of 30-day mortality and had no adverse effect on mortality after discharge, underscoring the "obesity paradox" in patients undergoing TAVI.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Robert M A
authors.initials: RM
authors.lastname: van der Boon
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dumonteil
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Gill L
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Olivier
authors.initials: O
authors.lastname: Vahdat
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D009765:Obesity / Q000150:complications* / Q000401:mortality; D016017:Odds Ratio; D011184:Postoperative Period; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome