355 - Influence of Diabetes and Glycemic Control on Mortality in Left Ventricular Assist Device Patients

Abstract

Introduction: Prior studies have shown that patients with diabetes have worse surgical outcomes compared with individuals without diabetes. Despite previous studies, the risk of mortality of diabetic patients post left ventricular assist device (LVAD) implant, remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVAD patients with diabetes has not been established. Hypothesis: We hypothesized that LVAD patients without diabetes would have lower mortality than LVAD patients with diabetes, and amongst LVAD diabetic patients, mortality would increase with worse diabetes control (higher hemoglobin A1c). Methods: 95 non-diabetic and 96 diabetic patients from the University of Rochester Medical Center, Rochester, NY who received a HeartMate II continuous-flow LVAD between 8/26/2007 and 6/30/2014 were included in this study. Diabetics were defined as having a diagnosis of diabetes in medical records, or hemoglobin A1c greater than or equal to 6.5%, or random glucose greater than 200 mg/dL on more than one occasion prior to LVAD implantation. The primary outcome was all-cause mortality. Kaplan-Meier cumulative probabilities of long-term all-cause mortality were assessed by diabetes, and by the degree of glycemic control. Results: During follow-up, 32 (33%) individuals with diabetes and 15 (16%) individuals without diabetes died following LVAD implantation (P = .005). Cumulative probability of death was higher in diabetics when compared to non-diabetics (42% vs. 21% at 3 years, P = .008, Fig. 1). There was no statistically significant difference in cumulative probability of death between diabetics with pre-LVAD hemoglobin A1c < 7.5% and diabetics with pre-LVAD hemoglobin A1c ≥7.5% (P = .198, Fig. 2). Conclusions: Diabetics who undergo LVAD implantation have a higher probability of death compared with non-diabetic patients. However, the degree of glycemic control in patients with diabetes did not influence mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)