Key result
Type 2 diabetes was associated with a significantly higher adjusted risk of in-hospital mortality in patients undergoing surgical aortic valve replacement (OR 1.115), but not in those undergoing transcatheter aortic valve replacement.
Why the study?
Diabetes is associated with higher cardiovascular events, but the trends and outcomes of aortic valve replacement in patients with diabetes needed assessment.
Does diabetes increase the risk of adverse in-hospital outcomes in patients undergoing aortic valve replacement?
Observational (n=428,427)
Yes
Does diabetes increase the risk of adverse in-hospital outcomes in patients undergoing aortic valve replacement?
Odds Ratio: 1.115 (95% CI 1.06–1.17)
p-value: p=<0.001
Patients with diabetes undergoing TAVR have similar in-hospital mortality to non-diabetics, whereas those undergoing sAVR face a higher mortality risk, suggesting TAVR may be preferable in this population.
Diabetes may heighten SAVR mortality risk; leaves open TAVR preference in diabetics pending randomized confirmation.
Aims We aimed to assess the trend and outcome of aortic valve replacement in patients with diabetes. Background Diabetes is associated with higher cardiovascular events. Methods Data from the National Inpatient Sample was analyzed between 2012 and 2017. We compared hospitalizations and in-hospital cardiovascular outcomes in patients with diabetes to those without diabetes, hospitalized for aortic valve replacement. Results In diabetes patients undergoing TAVR, the mean age of participants decreased from 79.6 ± 8 to 67.8 ± 8, hospitalizations increased from 0.97 to 7.68/100,000 US adults ( p < 0.002 for both). There was a significant temporal decrease in mortality, acute renal failure (ARF), and stroke. Compared to non-diabetic patients, those with diabetes had a higher risk of stroke, ARF, and pacemaker requirement [adjusted OR = 1.174 (1.03–1.34), 1.294 (1.24–1.35), 1.153 (1.11–1.20), respectively], but a similar adjusted mortality risk. In diabetes patients undergoing sAVR, the mean age of participants decreased from 70.4 ± 10 to 68 ± 9 ( p < 0.001), hospitalizations dropped from 7.72 to 6.63/100,000 US adults ( p = 0.025), so did mortality, bleeding, and ARF. When compared to non-diabetes patients, those with diabetes were older and had a higher adjusted risk of mortality, stroke, and ARF [adjusted OR= 1.115 (1.06–1.17), 1.140 (1.05–1.23), 1.217 (1.18–1.26); respectively]. Conclusion The recent temporal trend of aortic valve replacement in patients with diabetes shows a significant increase in TAVR coupled with a decrease in sAVR. Mortality and other cardiovascular outcomes decreased in both techniques. sAVR, but not TAVR, was associated with higher in-hospital mortality risk.
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Khan et al. (2022) conducted an observational in Aortic Valve Replacement (TAVR or sAVR) (n=428,427). Type 2 Diabetes vs. Non-diabetes was evaluated on In-hospital mortality (sAVR cohort) (OR 1.115, 95% CI 1.06-1.17, p=<0.001). Type 2 diabetes was associated with a significantly higher adjusted risk of in-hospital mortality in patients undergoing surgical aortic valve replacement (OR 1.115), but not in those undergoing transcatheter aortic valve replacement.
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