{"id":"aa752423d734","type":"article","url":"https://hartvaat.nl/2026/10/01/in-hospital-ami-bij-obesitas-tijdens-tavr-komt-even-vaak-voor-als-bij-niet-obese/","title":"In-hospital AMI bij obesitas tijdens TAVR komt even vaak voor als bij niet-obese patiënten","title_en":"Incidence and Factors Associated With In-Hospital Acute Myocardial Infarction in Patients With Obesity Undergoing Transcatheter Aortic Valve Replacement: A National Inpatient Sample Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Cardiology research","doi":"10.14740/cr2257","source_url":"https://doi.org/10.14740/cr2257","authors":["Li Li Zheng","Gui Zhen Xu","Xiao Jun Zeng","Zi Hao Zhou","Hao Xie","Tao Shi","Long Hua Liu","Yan Zhu","Xiang Hua Cao","Wen Gui Liu","Sheng Qi Xie"],"significance":5,"published":"2026-09-20","source_date":"2026-10-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/","https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/"],"congress":"","summary_en":"A retrospective analysis of the National Inpatient Sample (2016–2022) evaluated in-hospital acute myocardial infarction (AMI) rates among 19,971 obese patients undergoing transcatheter aortic valve replacement (TAVR). The incidence of AMI was 2.5%, comparable to non-obese patients (2.7%), but AMI episodes were strongly linked to higher mortality, prolonged hospital stays, and increased costs. Modifiable factors such as anemia, fluid and electrolyte disorders, and weight loss were associated with elevated AMI risk, whereas elective admission reduced it. These findings highlight the need for targeted preoperative optimization of specific comorbidities in obese patients undergoing TAVR.","created":"2026-09-14T00:46:31Z","updated":"2026-09-14T00:46:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve analyse van het National Inpatient Sample (2016-2022) onderzocht het risico op in-hospital AMI bij 19.971 patiënten met obesitas die een TAVR ondergingen. Het AMI-risico bedroeg 2,5%, wat niet significant verschilde van niet-obese patiënten (2,7%), maar was wel geassocieerd met hogere mortaliteit, langere hospitalisatie en hogere kosten. Factoren zoals anemie, vocht-elektrolytstoornissen en gewichtsverlies verhoogden het AMI-risico, terwijl electieve opname het beschermd. Deze bevindingen benadrukken de waarde van gerichte preoperatieve optimalisatie van modificeerbare risicofactoren bij zwaarlijvige TAVR-patiënten.","abstract_original":"BACKGROUND: The impact of obesity on acute myocardial infarction (AMI) risk in patients undergoing transcatheter aortic valve replacement (TAVR) remains poorly characterized, particularly with respect to the incidence and specific factors associated with this complication. This study aimed to determine the incidence, associated factors, and clinical implications of in-hospital AMI among patients with obesity undergoing TAVR. METHODS: We analyzed the National Inpatient Sample (2016-2022) to identify adult patients with obesity (body mass index (BMI) ≥ 30 kg/m2) undergoing TAVR, with non-obese patients as a comparative cohort. Multivariable logistic regression identified factors associated with in-hospital AMI. RESULTS: Among 19,971 patients with obesity undergoing TAVR, 506 (2.5%) experienced in-hospital AMI, compared with 2.7% among non-obese patients (P = 0.295). Patients with obesity were younger (median age 75 vs. 81 years, P < 0.001) and had lower in-hospital mortality (0.8% vs. 1.3%, P = 0.002) but longer hospital stays (3 vs. 2 days, P < 0.001) and higher hospitalization costs ($217,785 vs. $179,887, P < 0.001) compared with patients without obesity. Factors associated with higher AMI odds in the obesity cohort included medium hospital size (odds ratio (OR) 1.687, 95% confidence interval (CI) 1.086-2.619), large hospital size (OR 1.840, 95% CI 1.234-2.744), deficiency anemia (OR 1.466, 95% CI 1.196-1.796), chronic blood loss anemia (OR 2.960, 95% CI 1.604-5.463), congestive heart failure (OR 2.530, 95% CI 1.871-3.421), fluid and electrolyte disorders (OR 2.734, 95% CI 2.239-3.338), other neurological disorders (OR 2.092, 95% CI 1.453-3.011), peripheral vascular disorders (OR 1.260, 95% CI 1.017-1.561), pulmonary circulation disorders (OR 1.297, 95% CI 1.054-1.595), and weight loss (OR 2.156, 95% CI 1.400-3.319). Conversely, elective admission (OR 0.046, 95% CI 0.037-0.058) was associated with lower AMI odds. AMI was associated with higher mortality (3.8% vs. 0.8%), prolonged hospitalization (11 vs. 3 days), and increased costs ($349,531 vs. $217,785) (all P < 0.001). CONCLUSIONS: In-hospital AMI occurs in 2.5% of patients with obesity undergoing TAVR-a rate comparable to that of patients without obesity (2.7%, P = 0.295)-and is associated with worse outcomes. Despite lower overall mortality in the obesity cohort-consistent with the obesity paradox-AMI risk was not similarly attenuated, suggesting that the protective effect of obesity does not uniformly extend to all periprocedural complications. Rather than simply documenting an expected complication rate, the clinical value of our study lies in identifying potentially modifiable factors associated with AMI specifically in the obesity cohort-including anemia, fluid and electrolyte disorders, and weight loss-that may inform targeted preoperative optimization."}