title: Impact of diabetes mellitus on early and midterm outcomes after transcatheter aortic valve implantation (from a multicenter registry).
abstract: Several clinical and procedural factors have been identified as predictors of early and midterm events after transcatheter aortic valve implantation (TAVI), but incidence and prognostic impact of diabetes mellitus (DM), especially insulin treated, on short- and midterm outcomes remain to be defined. All consecutive patients who underwent TAVI at our institutions were enrolled and stratified according to DM status. All-cause mortality at 30 days or in hospital and at follow-up was the primary end point, whereas periprocedural complications, rates of myocardial infarction, stroke, and reintervention at follow-up were the secondary ones. All end points were adjudicated according to the Valve Academic Research Consortium definitions. In all, 511 patients were enrolled: 361 without DM, 78 with orally treated DM, and 72 with insulin-treated DM. Orally treated DM patients were more frequently women, whereas insulin-treated DM patients were younger. Thirty-day Valve Academic Research Consortium mortality was not significantly higher in patients with orally treated DM and insulin-treated DM compared with patients without diabetes (6.4%, 9.7%, and 4.7%, p = 0.09). Bleedings, vascular complications, postprocedural acute kidney injury, and periprocedural strokes were not significantly different in the 3 groups. At midterm follow-up (median 400 days), patients with insulin-treated DM had a significantly higher mortality rate (33.3% vs 18.6%, p = 0.01) and higher myocardial infarction incidence (8.3% vs 1.4%, p = 0.002) if compared with patients without diabetes. Strokes and reinterventions at follow-up were similar in the 3 groups. After multivariable adjustment, insulin-treated DM was independently correlated with death (hazard ratio 2, 95% confidence interval 1.3 to 3.3) and myocardial infarction (hazard ratio 3.73, 95% confidence interval 1.1 to 13). In conclusion, DM does not significantly affect rates of complications in patients who underwent TAVI. Insulin-treated DM, but not orally treated DM, is independently associated with death and myocardial infarction at midterm follow-up and should be included into future TAVI-dedicated scores.
authors: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: federico.conrotto@gmail.com.
authors: Federico
authors: F
authors: Conrotto
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Francesca
authors: F
authors: Giordana
authors: Division of Cardiac Surgery, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Stefano
authors: S
authors: Salizzoni
authors: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Corrado
authors: C
authors: Tamburino
authors: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors: Giuseppe
authors: G
authors: Tarantini
authors: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors: Patrizia
authors: P
authors: Presbitero
authors: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Marco
authors: M
authors: Barbanti
authors: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors: Valeria
authors: V
authors: Gasparetto
authors: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors: Marco
authors: M
authors: Mennuni
authors: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors: Massimo
authors: M
authors: Napodano
authors: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors: Marco L
authors: ML
authors: Rossi
authors: Division of Cardiac Surgery, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Michele
authors: M
authors: La Torre
authors: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Gaetana
authors: G
authors: Ferraro
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Pierluigi
authors: P
authors: Omedè
authors: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Paolo
authors: P
authors: Scacciatella
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Walter Grosso
authors: WG
authors: Marra
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Chiara
authors: C
authors: Colaci
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Claudio
authors: C
authors: Moretti
authors: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Maurizio
authors: M
authors: D'Amico
authors: Division of Cardiac Surgery, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Mauro
authors: M
authors: Rinaldi
authors: Division of Cardiology 1, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Fiorenzo
authors: F
authors: Gaita
authors: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors: Sebastiano
authors: S
authors: Marra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome