Diabetes mellitus in transfemoral transcatheter aortic valve implantation: a propensity matched analysis.

Autor: van Nieuwkerk AC; Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Santos RB; Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.; Department of Cardiology, Serviço Cardiologia, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal., Mata RB; Cardiología Intervencionista, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain., Tchétché D; Clinique Pasteur, Toulouse, France., de Brito FS Jr; Heart Institute, University of São Paulo Medical School, São Paulo, Brazil., Barbanti M; Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania CT, Italy., Kornowski R; Cardiology Department, Rabin Medical Center, Petach Tikva, Israel., Latib A; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.; Montefiore Medical Center, Department of Interventional Cardiology, New York, NY, USA., D'Onofrio A; Division of Cardiac Surgery, University of Padova, Padova, Italy., Ribichini F; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy., Baan J; Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Oteo-Dominguez J; Hospital Universitario Puerta de Hierro-Majadahonda, Calle Manuel de Falla 1, 28222, Majadahonda, Madrid, Spain., Dumonteil N; Clinique Pasteur, Toulouse, France., Abizaid A; Heart Institute, University of São Paulo Medical School, São Paulo, Brazil., Sartori S; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., D'Errigo P; National Centre for Global Health - Instituto Superiore di Sanità, Rome, Italy., Tarantini G; Division of Cardiac Surgery, University of Padova, Padova, Italy., Lunardi M; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy., Orvin K; Cardiology Department, Rabin Medical Center, Petach Tikva, Israel., Pagnesi M; Institute of Cardiology, Department of Medical and Surgical specialties, Radiological sciences and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy., Ghattas A; Clinique Pasteur, Toulouse, France., Amat-Santos I; CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid, Spain., Dangas G; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Mehran R; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Delewi R; Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. r.delewi@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Cardiovascular diabetology [Cardiovasc Diabetol] 2022 Nov 16; Vol. 21 (1), pp. 246. Date of Electronic Publication: 2022 Nov 16.
DOI: 10.1186/s12933-022-01654-x
Abstrakt: Background: Diabetes Mellitus (DM) affects a third of patients with symptomatic severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). DM is a well-known risk factor for cardiac surgery, but its prognostic impact in TAVI patients remains controversial. This study aimed to evaluate outcomes in diabetic patients undergoing TAVI.
Methods: This multicentre registry includes data of > 12,000 patients undergoing transfemoral TAVI. We assessed baseline patient characteristics and clinical outcomes in patients with DM and without DM. Clinical outcomes were defined by the second valve academic research consortium. Propensity score matching was applied to minimize potential confounding.
Results: Of the 11,440 patients included, 31% (n = 3550) had DM and 69% (n = 7890) did not have DM. Diabetic patients were younger but had an overall worse cardiovascular risk profile than non-diabetic patients. All-cause mortality rates were comparable at 30 days (4.5% vs. 4.9%, RR 0.9, 95%CI 0.8-1.1, p = 0.43) and at one year (17.5% vs. 17.4%, RR 1.0, 95%CI 0.9-1.1, p = 0.86) in the unmatched population. Propensity score matching obtained 3281 patient-pairs. Also in the matched population, mortality rates were comparable at 30 days (4.7% vs. 4.3%, RR 1.1, 95%CI 0.9-1.4, p = 0.38) and one year (17.3% vs. 16.2%, RR 1.1, 95%CI 0.9-1.2, p = 0.37). Other clinical outcomes including stroke, major bleeding, myocardial infarction and permanent pacemaker implantation, were comparable between patients with DM and without DM. Insulin treated diabetics (n = 314) showed a trend to higher mortality compared with non-insulin treated diabetics (n = 701, Hazard Ratio 1.5, 95%CI 0.9-2.3, p = 0.08). EuroSCORE II was the most accurate risk score and underestimated 30-day mortality with an observed-expected ratio of 1.15 in DM patients, STS-PROM overestimated actual mortality with a ratio of 0.77 and Logistic EuroSCORE with 0.35.
Conclusion: DM was not associated with mortality during the first year after TAVI. DM patients undergoing TAVI had low rates of mortality and other adverse clinical outcomes, comparable to non-DM TAVI patients. Our results underscore the safety of TAVI treatment in DM patients.
Trial Registration: The study is registered at clinicaltrials.gov (NCT03588247).
(© 2022. The Author(s).)
Databáze: MEDLINE
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