Study Examines Effect of Diabetes Mellitus on Clinical Outcomes of TAVR
November 20, 2017—Yigal Abramowitz, MD, et al published data in Circulation: Cardiovascular Interventions (2017;10:e005417) examining the short- and long-term risks that diabetes mellitus (DM) and insulin dependency may have on transcatheter aortic valve replacement (TAVR) outcomes in diabetic patients.
As summarized in Circulation: Cardiovascular Interventions, data evaluating the outcomes of TAVR in diabetic patients are limited by small sample size and contradictory results. Investigators analyzed data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Researchers used multivariate modeling to evaluate in-hospital mortality, 30-day mortality, and 1-year mortality in patients with and without DM who underwent TAVR. Of 47,643 patients treated with TAVR between November 2011 through September 2015 at 394 hospitals in the United States, 17,849 (37.5%) patients had DM, with 6,600 treated with insulin.
The 30-day mortality rate for TAVR-treated patients with DM was 5% (6.1% for patients treated with insulin and 4.4% in patients not treated with insulin; P < .001) versus 5.9% in patients without DM (P < .001). Overall, 1-year mortality was 21.8% in patients with DM (24.8% treated with insulin and 20.1% not treated with insulin P < .001) versus 21.2% in patients without DM (P = .274).
The investigators advised that DM was associated with increased 1-year mortality (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.13–1.49; P < .001). Subgroup multivariable analysis showed a stronger mortality association in diabetic patients treated with insulin (HR, 1.57; 95% CI, 1.28–1.91; P < .001) than in those not treated with insulin (HR, 1.17; 95% CI, 1.00–1.38; P = .052).