Abstract
BackgroundDiabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the effect of diabetes mellitus treated with insulin and oral antidiabetic drugs on clinical outcomes after TAVI.MethodsThis study is an analysis of 2000 patients who underwent TAVI between 2008 and 2015. Patients were stratified post hoc into the following categories: without diabetes (n = 1337), with diabetes treated with oral antidiabetic drugs (OAD; n = 387) and with diabetes treated using insulin (n = 276).ResultsThere was no significant difference in device success (89.5% vs 89.4% vs 88.8%, adjusted odds ratio (adjOR) 1.10 [95% confidence interval (CI) 0.64–1.91]) and VARC-2-defined major complications among the three groups of patients (without DM, OAD, and insulin, respectively). Minor but not major or disabling strokes (adjOR 2.19; 95% CI 1.11–4.3) and overall renal complications (but not stage 2/3 alone) (adjOR 1.46; 95% CI 1.18–1.81) were more common in patients with diabetes than in those without diabetes. Insulin-treated patients had a significantly lower survival rate than that of patients with orally treated diabetes and of those without diabetes at 1 year (75.7% vs. 84.5% vs 84.7%, pairwise p < 0.01) and 3 years (56.9% vs. 65.9% vs. 67.9%, adj. p < 0.05) after TAVI. However, insulin-treated diabetes was not identified as an independent risk factor for higher mortality in the first (HR 1.29; 95% CI 0.97–1.72, p = 0.084) and 3rd years (HR 1.21; 95% CI 0.98–1.49; p = 0.079) after multivariable adjustment.ConclusionsAlthough insulin-dependent DM is an established component of surgical risk assessment, it was not identified as an independent factor associated with reduced survival in TAVI. DM treated with oral antidiabetic drugs or insulin may have less role in decision making of treatment in TAVI candidates.
Highlights
Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI)
Patients with diabetes had a higher degree of frailty (30.8% vs 36.4% vs 41.3%, p < 0.001) as well as a higher EuroSCORE I (20.5 vs 20.6 vs 24.7, p = 0.015) than patients without DM
Procedural characteristics A SAPIEN valve was implanted in 17.7% of patients, while SAPIEN XT was implanted in 42.8%, SAPIEN 3 was implanted in 16.4%, CoreValve was implanted in 18.0%, Symetis was implanted in 4.3%, and JenaValve/Portico was implanted in 1.0%
Summary
Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). Some studies suggest a minor effect of diabetes on this procedure [15] while others significantly worse 30-day [16] and 1-year outcome [17,18,19]. This contradiction is reflected in the current risk assessment scores.
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