Yigal Abramowitz1, Sreekanth Vemulapalli1, Tarun Chakravarty1, Zhuokai Li1, Samir Kapadia1, David Holmes1, Roland A Matsouaka1, Alice Wang1, Wen Cheng1, James S Forrester1, Richard Smalling1, Vinod Thourani1, Michael Mack1, Martin Leon1, Raj R Makkar2. 1. From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.). 2. From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.). Raj.Makkar@cshs.org.
Abstract
BACKGROUND: Diabetes mellitus (DM) adversely affects morbidity and mortality for cardiovascular diseases and procedures. Data evaluating the outcomes of transcatheter aortic valve replacement (TAVR) in diabetic patients are limited by small sample size and contradictory results. We aimed to establish the magnitude of risk and the incremental influence of insulin dependency by examining short- and long-term adverse outcomes according to DM status and therapy in the world's largest TAVR registry. METHODS AND RESULTS: We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. In-hospital mortality, 30-day mortality, and 1-year mortality after TAVR in patients with and without DM were evaluated using multivariate modeling. Among 47 643 patients treated with TAVR from November 2011 through September 2015 at 394 US hospitals, there were 17 849 (37.5%) patients with DM. Overall, 6600 of the diabetic patients were insulin treated (IT). Thirty-day mortality was 5.0% in patients with DM (6.1% in IT DM and 4.4% in non-IT DM; P<0.001) versus 5.9% in patients without DM (P<0.001). Overall, 1-year mortality was 21.8% in patients with DM (24.8% in IT DM and 20.1% in non-IT DM; P<0.001) versus 21.2% in patients without DM (P=0.274). In a multivariable model, DM was associated with increased 1-year mortality (hazard ratio, 1.30; 95% confidence interval, 1.13-1.49; P<0.001). Subgroup multivariable analysis showed stronger mortality association in IT diabetics (hazard ratio, 1.57; 95% confidence interval, 1.28-1.91; P<0.001) than in non-IT diabetics (hazard ratio, 1.17; 95% confidence interval, 1.00-1.38; P=0.052). CONCLUSIONS: Our data establish the magnitude of short- and long-term risk conferred by DM and the incremental risk conferred by insulin dependency in the performance of TAVR. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01737528.
BACKGROUND:Diabetes mellitus (DM) adversely affects morbidity and mortality for cardiovascular diseases and procedures. Data evaluating the outcomes of transcatheter aortic valve replacement (TAVR) in diabeticpatients are limited by small sample size and contradictory results. We aimed to establish the magnitude of risk and the incremental influence of insulin dependency by examining short- and long-term adverse outcomes according to DM status and therapy in the world's largest TAVR registry. METHODS AND RESULTS: We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. In-hospital mortality, 30-day mortality, and 1-year mortality after TAVR in patients with and without DM were evaluated using multivariate modeling. Among 47 643 patients treated with TAVR from November 2011 through September 2015 at 394 US hospitals, there were 17 849 (37.5%) patients with DM. Overall, 6600 of the diabeticpatients were insulin treated (IT). Thirty-day mortality was 5.0% in patients with DM (6.1% in IT DM and 4.4% in non-IT DM; P<0.001) versus 5.9% in patients without DM (P<0.001). Overall, 1-year mortality was 21.8% in patients with DM (24.8% in IT DM and 20.1% in non-IT DM; P<0.001) versus 21.2% in patients without DM (P=0.274). In a multivariable model, DM was associated with increased 1-year mortality (hazard ratio, 1.30; 95% confidence interval, 1.13-1.49; P<0.001). Subgroup multivariable analysis showed stronger mortality association in IT diabetics (hazard ratio, 1.57; 95% confidence interval, 1.28-1.91; P<0.001) than in non-IT diabetics (hazard ratio, 1.17; 95% confidence interval, 1.00-1.38; P=0.052). CONCLUSIONS: Our data establish the magnitude of short- and long-term risk conferred by DM and the incremental risk conferred by insulin dependency in the performance of TAVR. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01737528.
Authors: Ankur Panchal; Andreas Kyvernitakis; Geetha Rayarao; Mark Doyle; Robert W W Biederman Journal: J Cardiothorac Surg Date: 2021-10-20 Impact factor: 1.637
Authors: Ayman Elbadawi; Ahmed H Mohamed; Islam Y Elgendy; Gbolahan O Ogunbayo; Michael Megaly; Hend I Shahin; Karim Mahmoud; Mohamed A Omer; Ahmed Abuzaid; Ken Fujise; Syed Gilani Journal: Cardiol Ther Date: 2019-11-11