Elevated preoperative AIP was independently associated with a 639% increase in all-cause mortality risk in patients with severe aortic stenosis undergoing TAVR.
Observational (n=314)
No
Does an elevated preoperative atherogenic index of plasma (AIP) predict increased mortality and MACCE in patients with severe aortic stenosis undergoing TAVR?
Elevated preoperative atherogenic index of plasma (AIP) is a strong, independent, and linear predictor of increased all-cause mortality, cardiovascular mortality, and MACCE in patients with severe aortic stenosis undergoing TAVR.
Effect estimate: aHR 7.39 (95% CI 2.57–21.27)
p-value: p=<0.001
Background The atherogenic index of plasma (AIP) is a recognized predictor of cardiovascular risk, yet its prognostic relevance in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains uncertain. Methods This single-center retrospective study included 314 severe AS patients who underwent TAVR between 2019 and 2023. Participants were stratified into tertiles by preoperative AIP (Q1 −0.12; Q2: −0.12 to 0.11; Q3 0.11). Outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiac and cerebrovascular events (MACCE). Multivariable Cox regression and restricted cubic spline (RCS) analyses assessed associations between AIP and clinical endpoints. Results Over a median follow-up of 29 months (47 all-cause deaths, 34 cardiovascular deaths, and 67 MACCE events), Kaplan–Meier analysis demonstrated progressively poorer outcomes with increasing AIP tertiles (all log-rank p 0.05). In multivariable Cox models, each 1-unit increase in AIP was independently associated with higher risks of all-cause mortality (aHR = 7.39, 95% CI 2.57–21.27), cardiovascular mortality (aHR = 11.24, 95% CI 3.25–38.90), and MACCE (aHR = 4.98, 95% CI 2.11–11.78). Restricted cubic spline analyses further confirmed significant linear dose–response relationships between AIP and all three endpoints (all P for nonlinearity 0.05), with risk increasing progressively above reference levels around 0.44–0.45. Significant interactions were observed in current smokers and patients with coronary heart disease (P for interaction 0.05), suggesting amplified AIP-associated risks in these subgroups. Conclusion Elevated preoperative AIP is independently and linearly associated with increased mortality and MACCE risks in patients with severe AS undergoing TAVR. AIP may serve as a readily available metabolic biomarker providing supplementary prognostic information.
Lin et al. (2026) conducted an observational in severe aortic stenosis (n=314). Transcatheter Aortic Valve Replacement (TAVR) was evaluated on all-cause mortality (aHR 7.39, 95% CI 2.57–21.27, p=<0.001). Elevated preoperative AIP was independently associated with a 639% increase in all-cause mortality risk in patients with severe aortic stenosis undergoing TAVR.