Department of Cardiology, Faculty of Medicine, University of Health Sciences, Sincan Education and Research Hospital, Ankara, Turkey.
Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey.
Braz J Cardiovasc Surg. 2024 Jul 22;39(4):e20230088. doi: 10.21470/1678-9741-2023-0088.
Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS).
To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI.
Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually.
The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c ≥ 6.5 and HbA1c ≤ 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level ≥ 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis.
In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c ≥ 6.5, and it was an independent predictor for long-term mortality.
接受心脏经导管或手术介入治疗的糖尿病（DM）患者通常与不良结局相关。经导管主动脉瓣植入术（TAVI）已成为无法手术、高危或中危手术、严重主动脉瓣狭窄（AS）患者的治疗选择。
评估 DM 和糖化血红蛋白（HbA1c）对 TAVI 后结局和生存的影响。
本回顾性研究纳入了 552 名接受 TAVI 的有症状的严重 AS 患者，其中 164 名（29.7%）患有 DM。在 30 天、6 个月和每年进行随访。
两组间器械成功率和与手术相关并发症的风险相似，除急性肾损伤外，DM 组更为常见（2.4%比 0%，P=0.021）。住院期间和第一年的死亡率在两组间相似（4.9%比 3.6%，P=0.490 和 15.0%比 11.2%，P=0.282）。HbA1c≥6.5 和 HbA1c≤6.49 两组间总死亡率存在统计学差异（34.4%比 15.8%，P<0.001）。多变量逻辑回归分析显示唯一的独立预测因素是胸外科医生协会评分（危险比[HR]1.28，95%置信区间[CI]1.09-1.51；P=0.003）和 HbA1c 水平≥6.5（HR 10.78，95% CI 2.58-21.50；P=0.003）。
在这项研究中，我们得出结论，DM 与 TAVI 后死亡率或并发症发生率增加无关。此外，HbA1c≥6.5 的患者死亡率更高，且是长期死亡率的独立预测因素。
