van Nieuwkerk Astrid C, Santos Raquel B, Sartori Samantha, Regueiro Ander, Tchétché Didier, Mehran Roxana, Delewi Ronak
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Cardiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
JTCVS Open. 2021 Mar 23;6:26-36. doi: 10.1016/j.xjon.2021.03.012. eCollection 2021 Jun.
This study sought to investigate the effect of body mass index on outcomes in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation.
A total of 12,381 patients undergoing transfemoral transcatheter aortic valve implantation were divided into body mass index categories: underweight (<18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25.0-29.9 kg/m), and obesity (>30 kg/m). Primary endpoints were differences in 30-day and 1-year all-cause mortality. Secondary endpoints included all other clinical endpoints such as stroke. Univariate and multivariate odds ratios were calculated using logistic and cox regression analyses.
Two percent (n = 205) of patients were underweight, 29% (n = 3564) were normal weight, 44% (n = 5460) were overweight, and 25% (n = 3152) were obese. Thirty-day mortality was lower in overweight (5.3%, odds ratio, 0.73; 95% confidence interval, 0.61-0.88; = .001) and obese patients (5.2%, odds ratio, 0.74; 95% confidence interval, 0.60-0.92; = .006), but higher in underweight (9.8%, odds ratio, 1.51; 95% confidence interval, 0.92-2.47; = .010) as compared to normal weight patients (6.9%). After multivariate adjustment, 30-day mortality was not significantly different across body mass index categories. However, 1-year mortality was higher in underweight patients (hazard ratio, 1.52; 95% confidence interval, 1.10-2.09; = .011). Stroke rates were comparable between body mass index groups.
For overweight and obese patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation, there was no 30-day difference in mortality compared with patients with normal weight. However, underweight patients showed higher rates of 1-year mortality after transcatheter aortic valve implantation.
本研究旨在调查体重指数对接受经导管主动脉瓣植入术的严重主动脉瓣狭窄患者预后的影响。
总共12381例接受经股动脉经导管主动脉瓣植入术的患者被分为不同的体重指数类别：体重过轻（<18.5kg/m²）、正常体重（18.5 - 24.9kg/m²）、超重（25.0 - 29.9kg/m²）和肥胖（>30kg/m²）。主要终点是30天和1年全因死亡率的差异。次要终点包括所有其他临床终点，如中风。使用逻辑回归和Cox回归分析计算单因素和多因素比值比。
2%（n = 205）的患者体重过轻，29%（n = 3564）的患者体重正常，44%（n = 5460）的患者超重，25%（n = 3152）的患者肥胖。超重患者（5.3%，比值比，0.73；95%置信区间，0.61 - 0.88；P = 0.001）和肥胖患者（5.2%，比值比，0.74；95%置信区间，0.60 - 0.92；P = 0.006）的30天死亡率较低，但体重过轻患者（9.8%，比值比，1.51；95%置信区间，0.92 - 2.47；P = 0.010）高于正常体重患者（6.9%）。多因素调整后，不同体重指数类别之间的30天死亡率无显著差异。然而，体重过轻患者的1年死亡率较高（风险比，1.52；95%置信区间，1.10 - 2.09；P = 0.011）。体重指数组之间的中风发生率相当。
对于接受经导管主动脉瓣植入术的严重主动脉瓣狭窄的超重和肥胖患者，与正常体重患者相比，30天死亡率无差异。然而，体重过轻的患者在经导管主动脉瓣植入术后1年死亡率较高。
Zotero 插件