背景:近年来,肥胖悖论在心血管风险预测中得到了越来越多的关注。我们旨在研究BMI对经导管主动脉瓣置换术(TAVR)后死亡率的影响。
方法:我们对接受TAVR的重度主动脉瓣狭窄患者进行了多中心回顾性分析。患者分为:体重过重(BMI<18.5),正常体重(18.5≤BMI<25),超重(25≤BMI<30)和肥胖(BMI≥30)。多因素cox比例风险模型用于比较全因死亡率。
结果:总共包括6688名患者(175名体重不足,2252正常体重,2368超重和1893肥胖)。患者的平均年龄为81±8岁,其中55%为男性。肥胖患者的合并症患病率较高,但总体STS评分较低。与体重不足相比,肥胖人群在TAVR后30天的死亡率较低,正常体重,和超重患者(1.6%与6.9%,3.6%,和2.8%,分别,p<0.001)。同样,肥胖患者的3年死亡率最低(17.1%vs.28.9%,24.5%和18.6%,分别,p<0.001)。在多变量分析中,与体重不足(HR:1.74,95%CI:1.30-2.40,p<0.001)和体重正常(HR:1.41,95%CI:1.21-1.63,p<0.001)相比,肥胖患者3年的长期全因死亡率仍然显著较低,但与超重患者(HR:1.10,95%CI:0.94-1.28,p=0.240)相比,肥胖患者3年的长期全因死亡率仍然显著较低.
结论:结论:在TAVR后,肥胖患者的短期和长期死亡率均有改善,观察到的死亡率在BMI较低的情况下逐渐增加.
BACKGROUND: Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR).
METHODS: We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR. Patients were categorized into: Underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Multivariate 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 of patients was 81 ± 8 years with 55% males. Patients with obesity had higher prevalence of comorbidities but a lower overall STS score. 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 patients with obesity (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 patients with obesity 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).
CONCLUSIONS: In conclusion, patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in mortality with lower BMI ranges.