Aims: Several factors have been identified as predictors of early and midterm events after TAVI, but incidence and prognostic impact of diabetes, especially if insulin dependent, on their short and mid outcomes remains to be defined. Methods and results: All consecutive patients undergoing TAVI at our Institutions were enrolled, and divided according to diabetes status. All-cause mortality at 30 days and at follow up was the primary end point, while periprocedural complications, rate of myocardial infarction, stroke, re-intervention at follow-up the secondary. All end points were adjudicated according to VARC. 511 patients were enrolled: 361 without diabetes, 78 with orally treated/diet controlled diabetes and 72 with insulin treated diabetes. Patients with orally treated diabetes were more frequently female and patients with insulin treated diabetes were younger. 30 days mortality was not significantly higher in patients with orally treated diabetes (6.4%) and insulin treated diabetes (9.7%) compared with not diabetic patients (4.7%, p=0.09). Bleedings, vascular complications, post procedural acute kidney injury and peri-procedural stroke were not significantly different in the three groups. At a median follow up of 400 days patients with insulin treated diabetes had a significantly higher mortality rate (33.3% Vs 18.6%, p=0.01), and higher myocardial infarction incidence (8.3% Vs 1.4%, p=0.002) if compared with patients without diabetes. Stroke and re-interventions at follow-up were similar in the three groups. After multivariable adjustment insulin treated diabetes was independently correlated with death (HR 1.75, 95% CI 1.1-2.8) and myocardial infarction (HR 5.6, 95% CI 1.5-20.5). Conclusion: Diabetes doesn't significantly affect rates of complications in TAVI patients. Insulin treated diabetes, but not orally treated diabetes, is independently associated with deaths and myocardial infarction at mid-term follow-up. Insulin treated diabetes should be included into dedicated scores to predict outcomes of patients after TAVI.
Impact of diabetes on outcomes after TAVI procedure: a multicentre registry
D'ASCENZO, FABRIZIO;SALIZZONI, STEFANO;GAITA, Fiorenzo;
2013-01-01
Abstract
Aims: Several factors have been identified as predictors of early and midterm events after TAVI, but incidence and prognostic impact of diabetes, especially if insulin dependent, on their short and mid outcomes remains to be defined. Methods and results: All consecutive patients undergoing TAVI at our Institutions were enrolled, and divided according to diabetes status. All-cause mortality at 30 days and at follow up was the primary end point, while periprocedural complications, rate of myocardial infarction, stroke, re-intervention at follow-up the secondary. All end points were adjudicated according to VARC. 511 patients were enrolled: 361 without diabetes, 78 with orally treated/diet controlled diabetes and 72 with insulin treated diabetes. Patients with orally treated diabetes were more frequently female and patients with insulin treated diabetes were younger. 30 days mortality was not significantly higher in patients with orally treated diabetes (6.4%) and insulin treated diabetes (9.7%) compared with not diabetic patients (4.7%, p=0.09). Bleedings, vascular complications, post procedural acute kidney injury and peri-procedural stroke were not significantly different in the three groups. At a median follow up of 400 days patients with insulin treated diabetes had a significantly higher mortality rate (33.3% Vs 18.6%, p=0.01), and higher myocardial infarction incidence (8.3% Vs 1.4%, p=0.002) if compared with patients without diabetes. Stroke and re-interventions at follow-up were similar in the three groups. After multivariable adjustment insulin treated diabetes was independently correlated with death (HR 1.75, 95% CI 1.1-2.8) and myocardial infarction (HR 5.6, 95% CI 1.5-20.5). Conclusion: Diabetes doesn't significantly affect rates of complications in TAVI patients. Insulin treated diabetes, but not orally treated diabetes, is independently associated with deaths and myocardial infarction at mid-term follow-up. Insulin treated diabetes should be included into dedicated scores to predict outcomes of patients after TAVI.
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