Impact of body mass index on outcomes in patients undergoing transfemoral transcatheter aortic valve implantationCentral MessagePerspective

• Published in: JTCVS open Vol. 6; pp. 26 - 36
• Main Authors: Astrid C. van Nieuwkerk, MD, Raquel B. Santos, MD, Samantha Sartori, PhD, Ander Regueiro, MD, Didier Tchétché, MD, Roxana Mehran, MD, Ronak Delewi, MD, PhD, Flavio S. De Brito, Jr., MD, PhD, Flavio Tarasoutchi, MD, Marco Barbanti, MD, Ran Kornowski, MD, Katia Orvin, MD, Azeem Latib, MD, Matteo Pagnesi, MD, Augusto D'Onofrio, MD, PhD, Giuseppe Tarantini, MD, PhD, Flavio Ribichini, MD, PhD, Mattia Lunardi, MD, Jan Baan, MD, PhD, Jan Tijssen, PhD, José P.S. Henriques, MD, PhD, Francisco Ten, Nicolas Dumonteil, MD, Angie Ghattas, MD, Paola D'Errigo, MSc, Juan Manuel Nogales, Thomas Modine, MD, George Dangas, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier 01-06-2021
• Subjects: aortic valve stenosis; body mass index; obesity; transcatheter aortic valve implantation; underweight
• EISSN: 2666-2736

Objective: 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. Methods: A total of 12,381 patients undergoing transfemoral transcatheter aortic valve implantation were divided into body mass index categories: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (>30 kg/m2). 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. Results: 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; P = .001) and obese patients (5.2%, odds ratio, 0.74; 95% confidence interval, 0.60-0.92; P = .006), but higher in underweight (9.8%, odds ratio, 1.51; 95% confidence interval, 0.92-2.47; P = .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; P = .011). Stroke rates were comparable between body mass index groups. Conclusions: 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.