TY - JOUR
T1 - Long-Term Outcomes Stratified by Body Mass Index in Patients Undergoing Transcatheter Aortic Valve Implantation
AU - Quine, Edward J.
AU - Dagan, Misha
AU - William, Jeremy
AU - Nanayakkara, Shane
AU - Dawson, Luke P.
AU - Duffy, Stephen J.
AU - Stehli, Julia
AU - Dick, Ron J.
AU - Htun, Nay M.
AU - Stub, Dion
AU - Walton, Antony S.
N1 - Funding Information:
Professor Stephen Duffy is a proctor for Medtronic and his work is supported by a National Health and Medical Research Council of Australia grant (No. 1111170 ). A/Prof. Antony Walton is a proctor for Medtronic and Abbott, on the Medical Advisory Board for Medtronic and receives grant support from Medtronic, Abbott and Edwards. A/Prof. Dion Stub receives a National Heart Foundation Fellowship and Viertel Foundation Award. Dr. Nay Min Htun receives a Royal Australasian College of Physicians Research Establishment Fellowship.
Funding Information:
Professor Stephen Duffy is a proctor for Medtronic and his work is supported by a National Health and Medical Research Council of Australia grant (No. 1111170). A/Prof. Antony Walton is a proctor for Medtronic and Abbott, on the Medical Advisory Board for Medtronic and receives grant support from Medtronic, Abbott and Edwards. A/Prof. Dion Stub receives a National Heart Foundation Fellowship and Viertel Foundation Award. Dr. Nay Min Htun receives a Royal Australasian College of Physicians Research Establishment Fellowship.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/12/15
Y1 - 2020/12/15
N2 - Transcatheter aortic valve implantation (TAVI) is emerging as the default strategy for older patients with severe, symptomatic, and trileaflet aortic stenosis. Increased body-mass index (BMI) is associated with a protective effect in patients undergoing percutaneous coronary intervention. We assessed whether elevated BMI was associated with a similar association in TAVI. We evaluated prospectively collected data from 634 patients who underwent TAVI at 2 centers from August 2008 to April 2019. Patients were stratified as normal weight (BMI 18.5 to 24.9 kg/m2, n = 214), overweight (25 to 29.9 kg/m2, n = 234), and obese (>30 kg/m2, n = 185). Outcomes were reported according to VARC-2 criteria. Mortality was assessed using Cox proportional hazards regression analysis (median follow-up 2 years). Kaplan-Meier analysis was used to estimate cumulative mortality. Baseline differences were seen in age (85 vs 84 vs 82, p <0.001), STS-PROM score (4.3 vs 3.4 vs 3.6, p <0.001), sex (50% vs 36% vs 55% female, p <0.001), clinical frailty score (p = 0.02), diabetes (21% vs 29% vs 40%, p <0.001), and presence of chronic obstructive pulmonary disease (COPD) (13% vs 13% vs 23%, p = 0.009). On multivariable analysis there was no mortality difference between normal and obese patients (hazard ratio [HR] 0.70, confidence interval [CI] 0.46 to 1.1 p = 0.11), however overweight patients had significantly lower mortality (HR 0.56 CI 0.38 to 0.85, p = 0.006). Variables independently associated with increased mortality were increasing age, male sex, COPD, previous balloon valvuloplasty, and higher STS-PROM. In conclusion, overweight patients have lower long-term mortality when compared with normal weight and obese patients undergoing TAVI.
AB - Transcatheter aortic valve implantation (TAVI) is emerging as the default strategy for older patients with severe, symptomatic, and trileaflet aortic stenosis. Increased body-mass index (BMI) is associated with a protective effect in patients undergoing percutaneous coronary intervention. We assessed whether elevated BMI was associated with a similar association in TAVI. We evaluated prospectively collected data from 634 patients who underwent TAVI at 2 centers from August 2008 to April 2019. Patients were stratified as normal weight (BMI 18.5 to 24.9 kg/m2, n = 214), overweight (25 to 29.9 kg/m2, n = 234), and obese (>30 kg/m2, n = 185). Outcomes were reported according to VARC-2 criteria. Mortality was assessed using Cox proportional hazards regression analysis (median follow-up 2 years). Kaplan-Meier analysis was used to estimate cumulative mortality. Baseline differences were seen in age (85 vs 84 vs 82, p <0.001), STS-PROM score (4.3 vs 3.4 vs 3.6, p <0.001), sex (50% vs 36% vs 55% female, p <0.001), clinical frailty score (p = 0.02), diabetes (21% vs 29% vs 40%, p <0.001), and presence of chronic obstructive pulmonary disease (COPD) (13% vs 13% vs 23%, p = 0.009). On multivariable analysis there was no mortality difference between normal and obese patients (hazard ratio [HR] 0.70, confidence interval [CI] 0.46 to 1.1 p = 0.11), however overweight patients had significantly lower mortality (HR 0.56 CI 0.38 to 0.85, p = 0.006). Variables independently associated with increased mortality were increasing age, male sex, COPD, previous balloon valvuloplasty, and higher STS-PROM. In conclusion, overweight patients have lower long-term mortality when compared with normal weight and obese patients undergoing TAVI.
UR - http://www.scopus.com/inward/record.url?scp=85092511491&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2020.09.039
DO - 10.1016/j.amjcard.2020.09.039
M3 - Article
C2 - 33017578
AN - SCOPUS:85092511491
SN - 0002-9149
VL - 137
SP - 77
EP - 82
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
ER -
