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Insulin-treated diabetes linked with mortality in TAVR
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The mortality rate among patients with insulin-treated diabetes was approximately 15% higher than the rate for those without diabetes at follow-up of more than 1 year in a cohort of patients who underwent transcatheter aortic valve replacement.
Researchers of the study, published in the American Journal of Cardiology, wrote that the impact of diabetes mellitus as a predictive factor for early and midterm events after TAVR has not been well assessed. They aimed to investigate individuals without diabetes and those treated with oral medications or insulin for short- and mid-term outcomes after the procedure.
The analysis included 361 patients without diabetes, 78 with diabetes treated with oral medications and 72 with diabetes treated with insulin.
Thirty-day all-cause mortality in hospital or at follow-up served as the primary outcome measure. Secondary endpoints included periprocedural complications, rates of MI, stroke and reintervention at follow-up.
Valve Academic Research Consortium definitions were used to adjudicate endpoints.
According to those definitions, no significant differences were observed in terms of mortality in either of the diabetes groups compared with the non-diabetes groups (orally treated arm, 6.4%; insulin-treated arm, 9.7%; non-diabetes arm, 4.7%; P=.09).
Similarly, no significant differences were reported between the three groups in terms of bleedings, vascular complications, post-procedural acute kidney injury and periprocedural strokes. All three groups also experienced similar rates of stroke and reintervention.
Results at follow-up of a median of 400 days indicated that patients in the insulin group had a mortality rate of 33.3% compared with 18.6% in the non-diabetes group (P=.01). Insulin-treated patients also had higher rates of MI than those without diabetes (8.3% vs. 1.4%; P=.002).
Multivariable analysis revealed an independent association between insulin-treated diabetes and mortality (HR=2; 95% CI, 1.3-3.3). Insulin use was also correlated with MI (HR=3.73; 95% CI, 1.1-13).
“[Diabetes mellitus] does not significantly affect rates of complications in patients who underwent [TAVR],” the researchers concluded, adding that the association between insulin and death or MI should be accounted for with regard to TAVR-dedicated scores.
Disclosure: The researchers report no conflicts of interest.
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