Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
Am J Cardiol. 2014 Feb 1;113(3):529-34. doi: 10.1016/j.amjcard.2013.10.025. Epub 2013 Nov 11.
Several clinical and procedural factors have been identified as predictors of early and midterm events after transcatheter aortic valve implantation (TAVI), but incidence and prognostic impact of diabetes mellitus (DM), especially insulin treated, on short- and midterm outcomes remain to be defined. All consecutive patients who underwent TAVI at our institutions were enrolled and stratified according to DM status. All-cause mortality at 30 days or in hospital and at follow-up was the primary end point, whereas periprocedural complications, rates of myocardial infarction, stroke, and reintervention at follow-up were the secondary ones. All end points were adjudicated according to the Valve Academic Research Consortium definitions. In all, 511 patients were enrolled: 361 without DM, 78 with orally treated DM, and 72 with insulin-treated DM. Orally treated DM patients were more frequently women, whereas insulin-treated DM patients were younger. Thirty-day Valve Academic Research Consortium mortality was not significantly higher in patients with orally treated DM and insulin-treated DM compared with patients without diabetes (6.4%, 9.7%, and 4.7%, p = 0.09). Bleedings, vascular complications, postprocedural acute kidney injury, and periprocedural strokes were not significantly different in the 3 groups. At midterm follow-up (median 400 days), patients with insulin-treated DM 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. Strokes and reinterventions at follow-up were similar in the 3 groups. After multivariable adjustment, insulin-treated DM was independently correlated with death (hazard ratio 2, 95% confidence interval 1.3 to 3.3) and myocardial infarction (hazard ratio 3.73, 95% confidence interval 1.1 to 13). In conclusion, DM does not significantly affect rates of complications in patients who underwent TAVI. Insulin-treated DM, but not orally treated DM, is independently associated with death and myocardial infarction at midterm follow-up and should be included into future TAVI-dedicated scores.
已经确定了一些临床和程序因素，这些因素可预测经导管主动脉瓣植入术（TAVI）后的早期和中期事件，但糖尿病（DM）的发生率和预后影响，特别是胰岛素治疗，对短期和中期结果的影响仍有待确定。所有在我们机构接受 TAVI 的连续患者都根据 DM 状况进行了登记和分层。30 天或住院期间及随访时的全因死亡率是主要终点，而围手术期并发症、心肌梗死、卒中和随访时的再介入率则是次要终点。所有终点均根据 Valve Academic Research Consortium 定义进行裁决。共有 511 例患者入选：361 例无 DM，78 例口服 DM 治疗，72 例胰岛素 DM 治疗。口服 DM 治疗的患者更常为女性，而胰岛素 DM 治疗的患者更年轻。与无糖尿病患者相比，口服 DM 和胰岛素 DM 患者的 30 天 Valve Academic Research Consortium 死亡率并无显著升高（6.4%、9.7%和 4.7%，p=0.09）。三组间的出血、血管并发症、术后急性肾损伤和围手术期卒中无显著差异。在中期随访（中位数 400 天）时，与无糖尿病患者相比，胰岛素 DM 患者的死亡率（33.3% vs. 18.6%，p=0.01）和心肌梗死发生率（8.3% vs. 1.4%，p=0.002）均显著升高。三组患者的随访期间的卒中和再介入相似。多变量调整后，胰岛素 DM 与死亡（危险比 2，95%置信区间 1.3 至 3.3）和心肌梗死（危险比 3.73，95%置信区间 1.1 至 13）独立相关。总之，DM 不会显著影响接受 TAVI 的患者的并发症发生率。胰岛素 DM（而非口服 DM）与中期随访时的死亡和心肌梗死独立相关，应纳入未来的 TAVI 专用评分。
