Lv Wenyu, Li Shuangjiang, Liao Yanbiao, Zhao Zhengang, Che Guowei, Chen Mao, Feng Yuan
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Interact Cardiovasc Thorac Surg. 2017 Oct 1;25(4):633-642. doi: 10.1093/icvts/ivx191.
Most recent studies have proposed the paradoxical benefits of obesity in surgical populations. For patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis, the prognostic roles of obesity and high body mass index remain controversial. Therefore, the objective of this meta-analysis was to evaluate whether the 'obesity paradox' exists in patients undergoing TAVI. We searched in PubMed and EMBASE to identify the eligible articles. Odds ratios and hazard ratios with the corresponding 95% confidence intervals (CI) were adopted for synthesizing short-term and long-term survival outcomes, respectively. The level of heterogeneity and the publication bias between studies were also estimated. Finally, there were 16 studies with 12 330 patients who met the eligibility criteria and who were thus included in this review. When body mass index was analysed as a continuous variable, each increase of 1 kg/m2 was significantly associated with the lower 30-day mortality rate (odds ratio = 0.95; 95% CI = 0.93-0.97; P < 0.001) and better long-term overall survival (hazard ratio = 0.96; 95% CI = 0.94-0.97; P < 0.001) for patients undergoing TAVI. The obese patients had a significantly lower risk of 30-day mortality after TAVI than did normal patients (odds ratio = 0.69; 95% CI = 0.50-0.95; P = 0.024). Further analyses indicated that the obesity could be predictive of more favourable long-term overall survival of TAVI (hazard ratio = 0.84; 95% CI = 0.72-0.97; P = 0.021). However, we found no difference in procedural complications between the obese and normal patients. In conclusion, higher body mass index and obesity seem to have protective benefits on both short-term and long-term survival of TAVI patients. Current evidence suggests that the 'obesity paradox' may really exist in TAVI.
最近的研究提出了肥胖在外科手术人群中的矛盾益处。对于因主动脉瓣狭窄接受经导管主动脉瓣植入术(TAVI)的患者,肥胖和高体重指数的预后作用仍存在争议。因此,本荟萃分析的目的是评估接受TAVI的患者中是否存在“肥胖悖论”。我们在PubMed和EMBASE中进行检索以确定符合条件的文章。分别采用比值比和风险比及其相应的95%置信区间(CI)来综合短期和长期生存结果。还估计了研究之间的异质性水平和发表偏倚。最后,有16项研究共12330例患者符合纳入标准并被纳入本综述。当将体重指数作为连续变量进行分析时,体重指数每增加1kg/m²与接受TAVI患者较低的30天死亡率(比值比=0.95;95%CI=0.93-0.97;P<0.001)和更好的长期总体生存率(风险比=0.96;95%CI=0.94-0.97;P<0.001)显著相关。肥胖患者TAVI术后30天死亡风险显著低于正常患者(比值比=0.69;95%CI=0.50-0.95;P=0.024)。进一步分析表明,肥胖可预测TAVI患者更有利的长期总体生存率(风险比=0.84;95%CI=0.72-0.97;P=0.021)。然而,我们发现肥胖患者与正常患者在手术并发症方面没有差异。总之,较高的体重指数和肥胖似乎对TAVI患者的短期和长期生存都有保护作用。目前的证据表明,“肥胖悖论”可能真的存在于TAVI中。