title: The obesity paradox in patients undergoing transcatheter aortic valve implantation.
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.
  
  
  OBJECTIVE
  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/m(2) ), normal weight (18.5-24.9 kg/m(2) ), overweight (25-29.9 kg/m(2) ), and obese (≥30 kg/m(2) ). 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.
authors: Department of Cardiology, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors: Maayan
authors: M
authors: Konigstein
authors: Ofer
authors: O
authors: Havakuk
authors: Yaron
authors: Y
authors: Arbel
authors: Ariel
authors: A
authors: Finkelstein
authors: Eyal
authors: E
authors: Ben-Assa
authors: Eran
authors: E
authors: Leshem Rubinow
authors: Yigal
authors: Y
authors: Abramowitz
authors: Gad
authors: G
authors: Keren
authors: Shmuel
authors: S
authors: Banai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
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