It is true that the most important thing is a good design, which will hopefully get you good performance with minimal and maintainable code.
However, in my experience, there are almost always additional optimizations that can be done after you have implemented your basic design. Things like "this part could make smarter choices with a more complicated heuristic", "we could use a faster datastructure here, though it requires a lot of bookkeeping", or "We could cut a lot of computation here with an ugly hack that cuts through the abstraction".
Of course, more code makes it harder to change the structure of the program, so it's the classic trade-off of maintainability versus optimization.
A good example of this, besides databases, is CPUs.
Modern CPUs use loads of silicon on complex optimization tricks; out-of-order execution, register renaming, prefetchers, cache snooping. And all that "bloat" is actually making it faster. You can't make a super-fast CPU by removing all the cruft to get a minimal design. (Or rather, you can make it faster for certain cases, but it would be slower at doing almost anything useful.)