After TAVR, overweight tied to lower mortality, adverse event rates
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After transcatheter aortic valve replacement, patients with BMI more than 25 kg/m2 had less all-cause mortality, aortic regurgitation and MI compared with those under that threshold, according to a meta-analysis.
“The observed ‘obesity paradox’ highlights the favorable outcome in overweight and obese patients undergoing cardiovascular surgical procedures. This paradox is suggested to be due to the comorbidities associated with a low BMI ... as well as the conservative selection of low-surgical-risk patients with fewer comorbidities in the obese and overweight population,” Rahul Gupta, MD, cardiologist at the Lehigh Valley Heart Institute in Allentown, Pennsylvania, and colleagues wrote. “It is unclear at which BMI value transcatheter aortic valve implantation (TAVI) should be considered as an appropriate method for correction of aortic stenosis.”
Gupta and colleagues conducted a systematic review and meta-analysis to compare the associations between varying BMI ranges on outcomes in TAVR between using cut points of 25 kg/m2 (overweight) and 30 kg/m2 (obese) to identify the BMI with higher discriminative value for adverse events after TAVR.
The results of the study were published in the European Journal of Preventive Cardiology.
The researchers identified 14 studies using the 25 kg/m2 cut point that included 14,137 patients (mean age, 81 years; 48% men) and 15 studies using the 30 kg/m2 cut point that included 17,512 patients (mean age, 81 years; 50% men).
The primary outcome was all-cause mortality. Secondary outcomes of interest included MI, stroke, moderate to severe aortic regurgitation, device success, vascular complications, bleeding and permanent pacemaker implantation.
Within studies using a 25 kg/m2 cut point, patients under the cut point had higher incidence of 30-day all-cause mortality (OR = 0.62; 95% CI, 0.46-0.85; P < .01), long-term all-cause mortality (OR = 0.79; 95% CI, 0.68-0.93; P < .01), 30-day MI (OR = 0.44; 95% CI, 0.24-0.81; P = .01) and moderate to severe aortic regurgitation (OR = 0.7; 95% CI, 0.54-0.9; P = .01) compared with those with overweight.
However, the incidence of permanent pacemaker implantation was lower among patients with BMI less than 25 kg/m2 compared with those with BMI 25 kg/m2 or more (OR = 1.18; CI, 1.13-1.35; P = .02).
There was no significant difference between the two groups for any of the other secondary outcomes.
Among participants in studies using a 30 kg/m2 cut point, researchers observed a significant difference only in the outcomes of aortic regurgitation, with a lower incidence among participants with obesity compared with those with BMI less than 30 kg/m2 (OR = 0.67; 95% CI, 0.47-0.96; P = .03).
None of the trials included in the systemic review and meta-analysis had high heterogeneity (I2 > 75%), according to the study.
“Our findings in a larger population revealed a significantly lower 30-day and long-term mortality in overweight patients, but the difference between the obese group vs. lower BMIs did not reach statistical significance, which is probably a result of including the overweight patients in the comparator arm,” the researchers wrote. “Moreover, we observed a reduced moderate/severe aortic regurgitation in both the overweight and obese population and a reduced MI in the overweight but not in the obese patients.”
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