Prognostic Value of the AIP Index in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Why It Matters

Identifying a simple, inexpensive biomarker that independently predicts TAVR outcomes can refine patient selection and post‑procedure management, potentially improving survival in a growing elderly cohort.

Key Takeaways

• Higher pre‑operative AIP predicts increased mortality after TAVR
• Risk rises linearly above AIP ≈0.45
• Smoking and coronary disease amplify AIP‑related risk
• AIP offers a low‑cost addition to TAVR risk models

Pulse Analysis

The prevalence of severe aortic stenosis rises sharply after age 65, making transcatheter aortic valve replacement the preferred therapy for many high‑risk patients. While procedural success rates have improved, clinicians still grapple with heterogeneous long‑term outcomes, prompting a search for readily available prognostic indicators. The atherogenic index of plasma (AIP), calculated as log₁₀(triglycerides/HDL‑cholesterol), has emerged as a robust surrogate for atherogenic lipoprotein burden and has been linked to coronary disease, stroke, and heart failure. Its simplicity—requiring only a standard lipid panel—makes it an attractive candidate for risk stratification in TAVR candidates.

In a single‑center retrospective cohort of 314 TAVR recipients, investigators found that each unit increase in pre‑operative AIP corresponded to a 7.4‑fold rise in all‑cause mortality and more than ten‑fold elevation in cardiovascular death after adjusting for age, sex, BMI, diabetes, and valve gradients. Restricted cubic spline analysis demonstrated a near‑linear relationship, with hazard ratios climbing once AIP exceeded roughly 0.45. Notably, the adverse impact was magnified in current smokers and patients with pre‑existing coronary artery disease, underscoring the interplay between metabolic dys‑lipidemia and existing atherosclerotic burden.

These results position AIP as a low‑cost, easily implementable addition to existing TAVR risk models such as the STS/ACC score. Incorporating AIP could help identify patients who may benefit from intensified lipid management or closer post‑procedure surveillance. However, the study’s retrospective design, single‑center scope, and lack of comparative analysis with established scores limit immediate clinical adoption. Prospective multicenter trials are needed to confirm the incremental predictive value of AIP and to test whether targeted interventions based on AIP levels can translate into improved survival and reduced MACCE rates.