# Prognostic value of the AIP index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

## TL;DR

Higher AIP levels before heart valve replacement are linked to worse outcomes in patients with severe aortic stenosis.

## Contribution

This study shows AIP is a strong independent predictor of mortality and cardiac events after TAVR in severe aortic stenosis patients.

## Key findings

- Higher AIP tertiles correlated with increased all-cause and cardiovascular mortality.
- AIP showed a linear dose-response relationship with MACCE events after TAVR.
- AIP risk was amplified in smokers and patients with coronary heart disease.

## Abstract

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.

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.

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.

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.