Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
Internal Medicine Department, Hospital Infanta Leonor, Madrid, Spain.
Cardiovasc Diabetol. 2019 May 10;18(1):60. doi: 10.1186/s12933-019-0866-5.
The main aims of this study were to examine the incidence and in-hospital outcomes of mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without T2DM.
We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients with SMVR codified in their discharge report. We grouped admissions by diabetes status. Propensity score matching (PSM) was used to compare outcomes of isolated SMVR.
We identified 42,937 patients (16.41% with T2DM). Incidence rates of mechanical and bioprosthetic SMVR were higher among T2DM patients than among non-T2DM patients. In both groups of patients, the use of bioprosthetic SMVR increased over time. The use of mechanical valves remained stable among T2DM patients. In T2DM and non-T2DM patients with mechanical SMVR, in hospital mortality (IHM) and MACCE decreased significantly (p < 0.001) from 2001 to 2015. T2DM patients had an overall 11.37% IHM, compared with 10.76% among non-T2DM patients (p = 0.176). Regarding MACCE figures were 14.72% vs. 14.22% (p = 0.320) after mechanical SMVR. Total crude IHM were 14.29% for T2DM patients and 15.13% for those without T2DM with bioprosthetic SMVR (p = 0.165) and 18.22 vs. 19.64%, for a MACCE (p = 0.185). Using PSM we found that the IHM and the MACCE of isolated SMVR did not differ significantly between patients with or without T2DM beside the type of valve replacement. Among T2DM patients, those who received bioprosthetic valves had higher IHM (14.29% vs. 11.37%; p = 0.003) and a higher rate of MACCE (18.22% vs. 14.72%; p = 0.001) than T2DM patients with mechanical SMVR.
In Spain from 2001 to 2015, the incidence rates of hospitalization to undergo mechanical or bioprosthetic SMVR were higher among the population suffering T2DM than among the non-T2DM population. In both groups of patients the use of bioprosthetic SMVR increased over time and the use of mechanical valves remained stable in T2DM. T2DM patients have IHM and MACCE after mechanical and bioprosthetic SMVR which are not significantly different to those found among non-diabetic patients. Among T2DM patients, the crude IHM was significantly higher in those who received a bioprosthetic SMVR than those with mechanical SMVR.
本研究的主要目的是研究有和没有 2 型糖尿病（T2DM）的患者行机械和生物瓣二尖瓣置换术（SMVR）的发生率和院内结局。
我们使用西班牙国家住院数据库进行了回顾性研究，时间范围为 2001 年至 2015 年。我们纳入了在出院报告中编码为 SMVR 的患者。我们根据糖尿病状况对入院进行分组。采用倾向评分匹配（PSM）比较孤立性 SMVR 的结局。
我们共确定了 42937 名患者（16.41%患有 T2DM）。T2DM 患者行机械和生物瓣 SMVR 的发生率高于非 T2DM 患者。在两组患者中，生物瓣 SMVR 的使用率随时间推移而增加。T2DM 患者中机械瓣膜的使用率保持稳定。在 T2DM 和非 T2DM 患者中，机械 SMVR 的院内死亡率（IHM）和主要不良心脑血管事件（MACCE）均显著降低（p<0.001）。T2DM 患者的总体 IHM 为 11.37%，而非 T2DM 患者为 10.76%（p=0.176）。MACCE 数据方面，机械 SMVR 后 T2DM 患者为 14.72%，非 T2DM 患者为 14.22%（p=0.320）。T2DM 患者行生物瓣 SMVR 的总 crude IHM 为 14.29%，而非 T2DM 患者为 15.13%（p=0.165），MACCE 分别为 18.22%和 19.64%（p=0.185）。采用 PSM 后我们发现，除了瓣膜置换类型外，T2DM 患者与非 T2DM 患者行孤立性 SMVR 的 IHM 和 MACCE 并无显著差异。在 T2DM 患者中，接受生物瓣的患者 IHM（14.29% vs. 11.37%；p=0.003）和 MACCE（18.22% vs. 14.72%；p=0.001）均高于接受机械瓣膜的患者。
在西班牙，2001 年至 2015 年期间，患有 2 型糖尿病的人群住院行机械或生物瓣二尖瓣置换术的发生率高于非 2 型糖尿病人群。在两组患者中，生物瓣 SMVR 的使用率随时间推移而增加，而 T2DM 患者的机械瓣膜使用率保持稳定。T2DM 患者行机械和生物瓣 SMVR 后的 IHM 和 MACCE 与非糖尿病患者无显著差异。在 T2DM 患者中，接受生物瓣 SMVR 的患者的 crude IHM 明显高于接受机械瓣 SMVR 的患者。
