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Cardiovascular Diabetology
Published in: Cardiovascular Diabetology 1/2019

Open Access 01-12-2019 | Transcatheter Aortic Valve Implantation | Original investigation

The association of diabetes mellitus treated with oral antidiabetic drugs and insulin with mortality after transcatheter valve implantation: a 3-year follow-up of the TAVIK registry

Authors: Panagiotis Tzamalis, Valentin Herzberger, Jens Bergmann, Alexander Wuerth, Peter Bramlage, Holger Schroefel, Claus Schmitt, Gerhard Schymik

Published in: Cardiovascular Diabetology | Issue 1/2019

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Abstract

Background

Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the effect of diabetes mellitus treated with insulin and oral antidiabetic drugs on clinical outcomes after TAVI.

Methods

This study is an analysis of 2000 patients who underwent TAVI between 2008 and 2015. Patients were stratified post hoc into the following categories: without diabetes (n = 1337), with diabetes treated with oral antidiabetic drugs (OAD; n = 387) and with diabetes treated using insulin (n = 276).

Results

There was no significant difference in device success (89.5% vs 89.4% vs 88.8%, adjusted odds ratio (adjOR) 1.10 [95% confidence interval (CI) 0.64–1.91]) and VARC-2-defined major complications among the three groups of patients (without DM, OAD, and insulin, respectively). Minor but not major or disabling strokes (adjOR 2.19; 95% CI 1.11–4.3) and overall renal complications (but not stage 2/3 alone) (adjOR 1.46; 95% CI 1.18–1.81) were more common in patients with diabetes than in those without diabetes. Insulin-treated patients had a significantly lower survival rate than that of patients with orally treated diabetes and of those without diabetes at 1 year (75.7% vs. 84.5% vs 84.7%, pairwise p < 0.01) and 3 years (56.9% vs. 65.9% vs. 67.9%, adj. p < 0.05) after TAVI. However, insulin-treated diabetes was not identified as an independent risk factor for higher mortality in the first (HR 1.29; 95% CI 0.97–1.72, p = 0.084) and 3rd years (HR 1.21; 95% CI 0.98–1.49; p = 0.079) after multivariable adjustment.

Conclusions

Although insulin-dependent DM is an established component of surgical risk assessment, it was not identified as an independent factor associated with reduced survival in TAVI. DM treated with oral antidiabetic drugs or insulin may have less role in decision making of treatment in TAVI candidates.
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Metadata
Title
The association of diabetes mellitus treated with oral antidiabetic drugs and insulin with mortality after transcatheter valve implantation: a 3-year follow-up of the TAVIK registry
Authors
Panagiotis Tzamalis
Valentin Herzberger
Jens Bergmann
Alexander Wuerth
Peter Bramlage
Holger Schroefel
Claus Schmitt
Gerhard Schymik
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2019
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-019-0873-6

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