Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 476-488

Incidence and Factors Associated With In-Hospital Acute Myocardial Infarction in Patients With Obesity Undergoing Transcatheter Aortic Valve Replacement: A National Inpatient Sample Analysis

↓ Figure 1. Flowchart of patient selection for in-hospital AMI among patients with obesity undergoing TAVR. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement.

↓ Figure 2. Annual incidence of in-hospital acute myocardial infarction among patients with obesity undergoing TAVR. TAVR: transcatheter aortic valve replacement.

↓ Figure 3. Factors associated with in-hospital AMI among patients with obesity undergoing TAVR. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement.

↓ Figure 4. Relationship between in-hospital AMI and preoperative comorbidities among patients with obesity undergoing TAVR. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement.

↓ Figure 5. Association between in-hospital complications and AMI among patients with obesity undergoing TAVR. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement.

↓ **Table 1.** Variables Used in Binary Logistic Regression Analysis
Variables categories	Specific variables
AIDS: acquired immunodeficiency syndrome.
Patient demographics	Age (≥ 18 years), sex (male and female), race (White, Black, Hispanic, Asian or Pacific Islander, Native American and Other)
Hospital characteristics	Type of admission (non-elective, elective), bed size of hospital (small, medium, large), teaching status of hospital (nonteaching, teaching), location of hospital (rural, urban), type of insurance (Medicare, Medicaid, private insurance, self-pay, no charge, other), location of the hospital (northeast, Midwest or north central, south, west)
Comorbidities	AIDS, alcohol abuse, deficiency anemia, rheumatoid diseases, chronic blood loss anemia, congestive heart failure, chronic pulmonary disease, coagulopathy, depression, diabetes (uncomplicated), diabetes (with chronic complications), drug abuse, hypertension, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, peptic ulcer disease, and weight loss

↓ Table 1. Variables Used in Binary Logistic Regression Analysis

Variables categories

Specific variables

AIDS: acquired immunodeficiency syndrome.

Patient demographics

Age (≥ 18 years), sex (male and female), race (White, Black, Hispanic, Asian or Pacific Islander, Native American and Other)

Hospital characteristics

Type of admission (non-elective, elective), bed size of hospital (small, medium, large), teaching status of hospital (nonteaching, teaching), location of hospital (rural, urban), type of insurance (Medicare, Medicaid, private insurance, self-pay, no charge, other), location of the hospital (northeast, Midwest or north central, south, west)

Comorbidities

AIDS, alcohol abuse, deficiency anemia, rheumatoid diseases, chronic blood loss anemia, congestive heart failure, chronic pulmonary disease, coagulopathy, depression, diabetes (uncomplicated), diabetes (with chronic complications), drug abuse, hypertension, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, peptic ulcer disease, and weight loss

↓ **Table 2.** Patient Characteristics and Outcomes of In-Hospital AMI Among Patients With Obesity Undergoing TAVR, With Non-Obese Comparison
Characteristics	Obesity without AMI	Obesity with AMI	P-value*	Non-obese overall
*P-value comparing obese with AMI vs. obese without AMI within the obesity cohort. All percentages are weighted. Weighted national estimates were derived using NIS discharge weights. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement; LOS: length of stay; NIS: National Inpatient Sample; TOTCHG: total charges.
Total (unweighted n, weighted N)	19,465 (weighted N = 97,325)	506 (weighted N = 2,530)	-	91,850 (weighted N = 459,250)
Total weighted incidence (%)	97.5%	2.5%	0.295	2.7%
Age (median, years)	75 (70, 81)	74 (68, 80)	0.009	81 (75, 86)
Age group (%)
18–64	10.0	13.8	0.005	4.9
≥ 65	90.0	86.2		95.1
Gender (%)
Male	49.9	52.6	0.235	57.8
Female	50.1	47.4		42.2
Race (%)
White	85.3	79.4	< 0.001	84.8
Black	4.6	6.5		3.7
Hispanic	4.6	9.7		4.7
Asian or Pacific Islander	0.5	0.2		1.6
Native American	0.3	0.2		0.3
Other	4.7	4.0		4.9
Number of comorbidity (%)
< 3	4.6	2.4	0.018	8.7
≥ 3	95.4	97.6		91.3
LOS (median, days)	3 (1,4)	11 (6,15)	< 0.001	2 (1,3)
TOTCHG (median, $)	217,785 (132,904–261,060)	349,531 (189,234–454,780)	< 0.001	179,887 (133,345–262,318)
Type of insurance (%)
Medicare	84.1	80.6	0.330	88.4
Medicaid	2.1	4.0		1.3
Private insurance	11.1	12.5		7.6
Self-pay	0.4	1.4		0.4
No charge	0.0	0.0		0.0
Other	2.2	1.6		2.1
Bed size of hospital (%)
Small	8.5	5.5	0.005	7.9
Medium	22.1	18.8		21.7
Large	69.4	75.7		70.4
Elective admission (%)	85.2	20.8	< 0.001	83.6
Type of hospital (teaching %)	89.4	88.7	0.658	89.4
Hospital location (%)
Rural	1.6	2.8	0.050	1.4
Urban	98.4	97.3		98.6
Region of hospital (%)
Northeast	20.9	23.3	0.001	22.9
Midwest or North Central	26.4	20.0		22.7
South	35.0	33.6		33.9
West	17.7	23.1		20.5
Died (%)	0.8	3.8	< 0.001	1.3

↓ Table 2. Patient Characteristics and Outcomes of In-Hospital AMI Among Patients With Obesity Undergoing TAVR, With Non-Obese Comparison

Characteristics

Obesity without AMI

Obesity with AMI

P-value*

Non-obese overall

*P-value comparing obese with AMI vs. obese without AMI within the obesity cohort. All percentages are weighted. Weighted national estimates were derived using NIS discharge weights. AMI: acute myocardial infarction; TAVR: transcatheter aortic valve replacement; LOS: length of stay; NIS: National Inpatient Sample; TOTCHG: total charges.

Total (unweighted n, weighted N)

19,465 (weighted N = 97,325)

506 (weighted N = 2,530)

91,850 (weighted N = 459,250)

Total weighted incidence (%)

97.5%

2.5%

0.295

2.7%

Age (median, years)

75 (70, 81)

74 (68, 80)

0.009

81 (75, 86)

Age group (%)

18–64

10.0

13.8

0.005

4.9

≥ 65

90.0

86.2

95.1

Gender (%)

Male

49.9

52.6

0.235

57.8

Female

50.1

47.4

42.2

Race (%)

White

85.3

79.4

< 0.001

84.8

Black

4.6

6.5

3.7

Hispanic

4.6

9.7

4.7

Asian or Pacific Islander

0.5

0.2

1.6

Native American

0.3

0.2

0.3

Other

4.7

4.0

4.9

Number of comorbidity (%)

< 3

4.6

2.4

0.018

8.7

≥ 3

95.4

97.6

91.3

LOS (median, days)

3 (1,4)

11 (6,15)

< 0.001

2 (1,3)

TOTCHG (median, $)

217,785 (132,904–261,060)

349,531 (189,234–454,780)

< 0.001

179,887 (133,345–262,318)

Type of insurance (%)

Medicare

84.1

80.6

0.330

88.4

Medicaid

2.1

4.0

1.3

Private insurance

11.1

12.5

7.6

Self-pay

0.4

1.4

0.4

No charge

0.0

Other

2.2

1.6

2.1

Bed size of hospital (%)

Small

8.5

5.5

0.005

7.9

Medium

22.1

18.8

21.7

Large

69.4

75.7

70.4

Elective admission (%)

85.2

20.8

< 0.001

83.6

Type of hospital (teaching %)

89.4

88.7

0.658

89.4

Hospital location (%)

Rural

1.6

2.8

0.050

1.4

Urban

98.4

97.3

98.6

Region of hospital (%)

Northeast

20.9

23.3

0.001

22.9

Midwest or North Central

26.4

20.0

22.7

South

35.0

33.6

33.9

West

17.7

23.1

20.5

Died (%)

0.8

3.8

< 0.001

1.3