Obesity (BMI ≥ 30) was not associated with a significant difference in one-year all-cause mortality compared to non-obese patients undergoing TAVI (OR 0.84; 95% CI 0.48-1.46; p=0.543).
Meta-Analysis (n=38,962)
Does obesity improve one-year all-cause mortality in patients undergoing TAVI?
This meta-analysis demonstrates that obesity does not confer a survival benefit in patients undergoing TAVI, challenging the existence of an obesity paradox in this setting.
Odds Ratio: 0.84 (95% CI 0.48–1.46)
p-value: p=0.543
Abstract Background Obesity has been associated with a paradoxical survival benefit in certain cardiovascular conditions, a phenomenon known as the "obesity paradox." However, its impact on outcomes following transcatheter aortic valve implantation (TAVI) remains unclear. Methods A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, LILACS, and Google Scholar. We included studies published between 2018 and 2024 that compared obese (BMI ≥ 30) and non-obese (BMI 18.5–25) patients undergoing TAVI. The primary outcome was one-year all-cause mortality, while secondary outcomes included stroke and bleeding complications. Results After a systematic review of 13 studies, comprising 38962 patients, it was possible to look over the prospect of the "obesity paradox" in TAVI. The findings challenge the assumption that obesity offers a protective effect, as most studies reported lower mortality and bleeding rates in obese patients. However, this "protective" interpretation has limitations, given that BMI doesn't differentiate between fat and muscle mass, leading to big misclassifications. Notably, studies focusing on severely obese individuals showed worse outcomes, suggesting that excess adiposity may still be harmful. In this same way, the meta-analysis revealed no significant difference in all-cause mortality (OR 0.84, 95% CI 0.48–1.46, p = 0.543), a non-significant increase in stroke risk (OR 1.14, 95% CI 0.91–1.43, p = 0.239), and a non-significant lower bleeding risk (OR 1.07, 95% CI 0.48–2.40, p = 0.863). Sensitivity analyses supported the robustness of these findings. Conclusion This systematic review and meta-analysis suggest that obesity does not confer a survival benefit in TAVI. While mild obesity is not associated with increased mortality, severe obesity may be linked to worse outcomes. Further standardized studies are needed to clarify the true impact of BMI on TAVI outcomes.
Silva et al. (Sat,) conducted a meta-analysis in patients undergoing TAVI (n=38,962). Obesity (BMI ≥ 30) vs. Non-obese (BMI 18.5–25) was evaluated on one-year all-cause mortality (OR 0.84, 95% CI 0.48-1.46, p=0.543). Obesity (BMI ≥ 30) was not associated with a significant difference in one-year all-cause mortality compared to non-obese patients undergoing TAVI (OR 0.84; 95% CI 0.48-1.46; p=0.543).