Department of Cardiac Surgery, Tel Aviv University, Tel Aviv, Israel.
Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiovasc Diabetol. 2019 Mar 15;18(1):31. doi: 10.1186/s12933-019-0836-y.
Diabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR.
We performed an observational study in a large tertiary medical center over a 14-year period (2004-2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months.
Short-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03-1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05-2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis.
Type 2 DM is an independent predictor for long-term mortality after isolated AVR surgery.
糖尿病（DM）对主要动脉粥样硬化相关心血管疾病的发病率和死亡率有不利影响，并与主动脉瓣狭窄的发生风险增加有关。关于 DM 对接受主动脉瓣置换术（AVR）患者结局的临床数据显示结果不一致。本研究旨在探讨和比较 2 型 DM 对接受单纯 AVR 的 DM 和非 DM 患者短期、中期和长期死亡率的影响。
我们在一家大型三级医疗中心进行了一项观察性研究，时间跨度为 14 年（2004-2018 年），包括所有首次接受单纯 AVR 手术的患者。在 1053 名研究患者中，346 名（33%）患有 2 型 DM（DM 组），并与非 DM（非 DM 组）患者（67%）进行比较。评估短期（住院期间）、中期（1 年和 3 年）和长期（5 年和 10 年）死亡率。平均随访时间为 69±43 个月。
DM 组与非 DM 组的短期（住院期间）死亡率相似：3.5%和 2.5%（p=0.517）。DM 组的中期死亡率（1 年和 3 年）高于非 DM 组，但无统计学意义：8.1%比 5.7%（p=0.169）和 12.1%比 8.3%（p=0.064）。长期（5 年和 10 年）死亡率在 DM 组明显高于非 DM 组：19.4%比 12.9%（p=0.007）和 30.3%比 23.5%（p=0.020）。在 346 名 DM 患者中，55 名（16%）接受胰岛素治疗，291 名（84%）仅接受口服降糖药物治疗。胰岛素治疗的 DM 患者的总体住院死亡率为 7.3%，而非胰岛素治疗的 DM 患者为 2.7%（p=0.201）。与非胰岛素治疗的 DM 患者相比，胰岛素治疗的 DM 患者亚组的长期死亡率更高，总体死亡率为 36.4%比 29.2%（p=0.039）。此外，多变量分析校正混杂因素后，DM（HR 1.39 CI 1.03-1.86，p=0.031）和胰岛素治疗（HR 1.76 CI 1.05-2.94，p=0.033）是晚期死亡率的预测因素。
2 型 DM 是单纯 AVR 术后长期死亡率的独立预测因素。
