Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p<0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.