Prognostic impact of obesity in acute aortic syndrome patients

Obesity is a global health problem with a well-known prognostic impact on cardiovascular pathologies. The influence of obesity and body mass index (BMI) on the prognosis of patients with acute aortic syndrome (AAS) is not clearly defined. Our aim is to evaluate whether overweight or obesity are associated with worse AAS prognosis.

All patients with AAS attended in a tertiary centre from April-2019 to 2024 were prospectively and consecutively collected. Height and weight at admission were recorded and patients were classified according to BMI into normal-weight (18.5 ≤BMI<25), overweight (25 ≤BMI<30) and obese (BMI≥30). Clinical, analytical, imaging and prognostic variables were analysed. Multivariate logistic regression analysis was performed to identify prognostic factors including age, sex, history of atrial fibrillation, and cardiovascular risk factors (hypertension, diabetes, obesity, peripheral artery disease, chronic kidney disease).

A total of 132 patients with AAS were included (table). Overweight or obese patients were more prevalent and significantly younger (p=0.011): normal weight (age 70±18.6 years), overweight (age 64±13.4 years) and obese (age 67±11, 4 years).

No differences were found in the AAS type diagnosed between groups(p=0.524): type A AAS was the most prevalent (73% normal-weight, 67% overweight and 75% obese) and aortic dissection the most common subtype (76% normal-weight, 82% overweight and 85% obese).

Clinical presentation was similar between the three groups of patients (Table). Although the differences were not statistically significant, type A AAS patients with obesity had a higher percentage of complications on admission (Table). Regarding in-hospital evolution, obese type A AAS patients had higher overall 30-day mortality and higher postoperative mortality (Figure). In a multivariate analysis, obesity showed a significant independent association with higher 30-day mortality (OR 6.86, 95%CI (1.30-36.2), p=0.023).

In this AAS patient population, two thirds had overweight or obesity, according to BMI. Patients with obesity showed worse prognosis and higher mortality compared to overweight patients.

Obesity was independently associated with a higher mortality.

Mortality in AAS according to weight