The obesity paradox in patients undergoing transcatheter aortic valve implantation.

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/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.