Is there an obesity paradox in cardiovascular outcomes for 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: ). Data were pooled using a random-effects model, with risk ratios (RRs) and their 95 % confidence intervals (CIs) as effect measures. Statistical significance was set at p < 0.05. Results: Our study, analyzing five observational studies with 7580 obese and 74,717 non-obese patients, found no significant difference in in-hospital mortality between the groups (RR: 0.85; p = 0.427). Subgroup analysis indicated a higher mortality risk for underweight patients compared to overweight (RR: 1.48; p = 0.006) and obese patients (RR: 1.40; p = 0.036), though the difference between underweight and normal-weight patients was not significant (RR: 1.18; p = 0.216). The risks of myocardial infarction (RR: 1.10; p = 0.592) and stroke (RR: 0.43; p = 0.166) were also similar between obese and non-obese patients. Conclusions: In conclusion, our analysis found no significant difference in in-hospital mortality, myocardial infarction or stroke risk between obese and non-obese patients undergoing TEER. However, underweight patients may have a higher risk of in-hospital mortality compared to overweight and obese individuals, highlighting the potential impact of BMI on outcomes in TEER patients.