Ando Tomo, Takagi Hisato, Briasoulis Alexandros, Umemoto Takuya
Detroit Medical Center, Division of Cardiology, Detroit, MI, USA.
Shizuoka Medical Center, Division of Cardiovascular Surgery, Shizuoka, Japan.
J Cardiol. 2017 Nov;70(5):484-490. doi: 10.1016/j.jjcc.2017.01.005.
Diabetes mellitus (DM) is well known to increase mortality in several cardiovascular diseases. However, the prognostic impact of DM following transcatheter aortic valve implantation (TAVI) remains controversial. We sought to assess the impact of DM on perioperative (in-hospital or 30-day) complications and mid-term (≥1 year) all-cause mortality after TAVI through meta-analysis.
A comprehensive literature search of PUBMED and EMBASE was conducted through January 1st 2002 to May 15th 2016. Articles that reported adjusted hazards ratio (HRs) or unadjusted HR for mid-term all-cause mortality with 95% confidence intervals (CIs) of DM or insulin dependent DM (IDDM) on mid-term all-cause mortality post TAVI were included in the analysis. A meta-analysis was performed with combination of both adjusted HR and un-adjusted HR. Sensitivity analysis was performed with only the adjusted HR. Random-effects model was used to calculate the pooled effect size.
A total of 22 observational cohort studies were identified with 28,440 (8998 DM and 19,442 non-DM) patients. The risk of perioperative complications (myocardial infarction, bleeding, major vascular complications, stroke, and new-onset atrial fibrillation) was similar between DM and non-DM cohorts. A meta-analysis of all-cause mortality of DM (19 studies after excluding 3 studies that only reported HR of IDDM on mid-term all-cause mortality, 8808 DM and 17,829 non-DM patients) resulted in significantly worse outcome (HR 1.21, 95%CI 1.10-1.34, p=0.0002, I=53%) in DM patients compared to non-DM patients post-TAVI. Sensitivity analysis showed consistent results. Subgroup analysis (4 studies with 267 IDDM versus 2161 non-IDDM) demonstrated that IDDM was associated with higher all-cause mortality (HR 2.05, 95%CI 1.54-2.73, p<0.00001, I=0%) following TAVI.
DM was associated with similar perioperative complications but was associated with increased mid-term all-cause mortality after TAVI. Further study of the causes of increased mortality during the follow-up may lead to improved outcome.
糖尿病（DM）会增加多种心血管疾病的死亡率，这是众所周知的。然而，经导管主动脉瓣植入术（TAVI）后糖尿病的预后影响仍存在争议。我们试图通过荟萃分析评估糖尿病对TAVI术后围手术期（住院期间或30天内）并发症和中期（≥1年）全因死亡率的影响。
对2002年1月1日至2016年5月15日期间的PUBMED和EMBASE进行全面文献检索。纳入分析的文章需报告糖尿病或胰岛素依赖型糖尿病（IDDM）对TAVI术后中期全因死亡率的调整后风险比（HRs）或未调整HR以及95%置信区间（CIs）。对调整后HR和未调整HR进行合并荟萃分析。仅对调整后HR进行敏感性分析。采用随机效应模型计算合并效应量。
共确定了22项观察性队列研究，涉及28440例患者（8998例糖尿病患者和19442例非糖尿病患者）。糖尿病组和非糖尿病组围手术期并发症（心肌梗死、出血、主要血管并发症、中风和新发房颤）的风险相似。对糖尿病患者全因死亡率的荟萃分析（排除3项仅报告IDDM对中期全因死亡率HR的研究后，纳入19项研究，8808例糖尿病患者和17829例非糖尿病患者）显示，与TAVI术后非糖尿病患者相比，糖尿病患者的预后明显更差（HR 1.21，95%CI 1.10 - 1.34，p = 0.0002，I = 53%）。敏感性分析结果一致。亚组分析（4项研究，267例IDDM患者与2161例非IDDM患者）表明，TAVI术后IDDM与更高的全因死亡率相关（HR 2.05，95%CI 1.54 - 2.73，p < 0.00001，I = 0%）。
糖尿病与相似的围手术期并发症相关，但与TAVI术后中期全因死亡率增加相关。对随访期间死亡率增加原因的进一步研究可能会改善预后。
