Lv Wenyu, Li Shuangjiang, Zhao Zhengang, Liao Yanbiao, Li Yijian, Chen Mao, Feng Yuan
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Interact Cardiovasc Thorac Surg. 2018 Aug 1;27(2):159-168. doi: 10.1093/icvts/ivy040.
Prior studies have proposed the unfavourable roles of diabetes mellitus (DM) in surgical populations. For patients who underwent transcatheter aortic valve implantation, the prognostic value of DM remains controversial. This review summarizes the effects of DM on short-term, mid-term and long-term prognosis in patients who undergo transcatheter aortic valve implantation. We searched the PubMed database to identify eligible articles. The odds ratio and hazard ratio with the corresponding 95% confidence interval were adopted for synthesizing short-term and medium- to long-term survival outcomes, respectively. The heterogeneity level and publication bias between studies were also estimated. Finally, 20 observational studies enrolling 19 260 patients met the eligibility criteria and, thus, were included in this review. An overall analysis identified that DM was significantly associated with the poor medium- to long-term overall survival (hazard ratio 1.21, 95% confidence interval 1.03-1.41; P = 0.019). However, no significant impact of DM on 30-day mortality was observed (odds ratio 1.10, 95% confidence interval 0.86-1.41; P = 0.46) in patients undergoing transcatheter aortic valve implantation. Further subgroup analyses indicated that the prognostic value of DM for medium- to long-term overall survival remained significant in the subgroups of multivariable origins of incorporated data, duration of follow-ups (1-year/≥2-year follow-up), Western populations and insulin-dependent diabetes mellitus. This meta-analysis demonstrates that DM is a strongly independent predictor for poor medium- to long-term overall survival but shows no significant effect of DM on 30-day mortality. Our findings need to be further verified and modified by more worldwide studies.
先前的研究提出了糖尿病（DM）在手术人群中的不利作用。对于接受经导管主动脉瓣植入术的患者，DM的预后价值仍存在争议。本综述总结了DM对接受经导管主动脉瓣植入术患者短期、中期和长期预后的影响。我们检索了PubMed数据库以识别符合条件的文章。分别采用比值比和风险比及相应的95%置信区间来综合短期和中长期生存结果。还估计了研究之间的异质性水平和发表偏倚。最后，20项纳入19260例患者的观察性研究符合纳入标准，因此被纳入本综述。一项综合分析发现，DM与较差的中长期总生存率显著相关（风险比1.21，95%置信区间1.03 - 1.41；P = 0.019）。然而，在接受经导管主动脉瓣植入术的患者中，未观察到DM对30天死亡率有显著影响（比值比1.10，95%置信区间0.86 - 1.41；P = 0.46）。进一步的亚组分析表明，在纳入数据的多变量来源、随访时间（1年/≥2年随访）、西方人群和胰岛素依赖型糖尿病亚组中，DM对中长期总生存的预后价值仍然显著。这项荟萃分析表明，DM是中长期总生存不良的一个强有力的独立预测因素，但对30天死亡率没有显著影响。我们的研究结果需要更多的全球研究进一步验证和修正。
