Abstract 13658: The Clinical Impact of Diabetes Mellitus on Outcome After Transcatheter Aortic Valve Replacement

Abstract

Background: DM adversely affects morbidity and mortality for cardiovascular diseases and procedures. DM has been independently associated with increased morbidity and mortality after surgical aortic valve replacement. There is limited data on the impact of DM on the prognosis of patients with severe aortic stenosis that undergo TAVR. In a sub-study of the PARTNER trial, 1-year mortality was significantly higher in patients without DM compared to patients with diabetes, although multivariable analysis was not performed. We aimed to evaluate the clinical characteristics and the early and midterm outcomes after TAVR according to DM status. Methods & Results: We examined 802 consecutive patients that underwent TAVR: 548 patients without DM, 177 patients with orally treated DM and 77 with insulin treated DM. Patients with DM were younger (mean age 80±8.4 vs. 82.9±8.8; p<0.01), had higher BMI (29±6.8 vs. 25.8±5; p<0.01), had higher incidence of CAD (70.9% vs. 61.5%; p=0.01) and lower incidence of frailty (28% vs. 37.6%; 0=0.01). Device success, postprocedural perivalvular leak and 30-days mortality and major complications rates were similar between groups (Table). In a Cox multivariable regression analysis including age, BMI, CAD and frailty, DM was associated with decreased overall survival. This was driven by increased overall mortality of the insulin treated DM subgroup (Figure). Conclusions: DM does not significantly affect short term mortality or rates of complications in patients who underwent TAVR. Insulin treated DM, but not orally treated DM, is independently associated with death at midterm follow up and should be included into future TAVR dedicated scores.