Obesity Paradox in Transcatheter Aortic Valve Replacement

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We sought to investigate the impact of BMI on mortality following TAVR. Methods: Multi-center retrospective analysis of patients with severe AS undergoing TAVR. Patients were categorized into: Underweight (BMI< 18.5), normal weight (18.5≤BMI< 25), overweight (25 ≤BMI< 30) and obese (BMI≥ 30). Cox-proportional hazard model was used to compare all-cause mortality. Results: Total of 6688 patients included (175 underweight, 2252 normal weight, 2368 overweight and 1893 with obesity). Mean age was 81±8 years with 55% males. Obese patients had higher prevalence of comorbidities but a lower overall STS score (Fig 1A). Mortality at 30-days post-TAVR was lower in the obese population compared to underweight, normal weight, and overweight patients (1.6% vs. 6.9%, 3.6%, and 2.8%, respectively, p<0.001). Similarly, 3-year mortality was lowest in obese patients (17.1% vs 28.9%, 24.5% and 18.6%, respectively, p<0.001). On multivariate analysis, long term all-cause mortality at 3-years remained significantly lower in the obese compared to underweight (HR 1.74, 95% CI: 1.30-2.40, p<0.001) and normal weight (HR: 1.41, 95% CI:1.21-1.63, p<0.001) but not in overweight patients (HR: 1.10, 95% CI:0.94-1.28, p=0.240). (Fig1B) Conclusion: Patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in all-cause mortality with lower BMI ranges.

Volume

83

Issue

13 Suppl

First Page

895

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)02885-7

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