Abstract 14902: Should Diabetic Status be Part of the Risk Calculation for TAVR Candidates? Insights from the France2 Registry
Background: Diabetes mellitus (DM) is involved in aortic stenosis development, with a negative impact on immediate and long term outcome after surgical aortic replacement. Accordingly, while DM is not part of the Euroscore, it has been integrated to the STS score. The impact of DM on post transcatheter aortic valve replacement (TAVR) outcome is unknown.
Methods: 3195 consecutive patients were enrolled between January 2010 and October 2011 in 33 centers. Before discharge, a perivalvular AR grade ≥ 2 by transthoracic echocardiography was considered significant. Mean follow-up was 302±164 days.
Results: 25.8% of the population had DM. Compared to non-DM patients, DM patients were younger (81.0±6.7 vs 83.3±7.3 years, p<0.0001), more likely men (55.3% vs 49.5%, p=0.005), with a higher BMI (27.9±5.1 vs 25.4±4.7 kg/m2, p<0.0001), a lower LVEF (52.1±13.7% vs 53.5±14.3%, p=0.01) and more comorbidities including: coronary artery disease (56.7% vs 44.9%, p<0.0001), history of MI (21.2% vs 14.5%, p<0.0001), peripheral arterial disease (26.8% vs 18.7%, p<0.0001) or renal failure (12.2% vs 8.4%, p=0.001). While the STS score was higher in DM than in non-DM patients (15.6±12.5 vs 13.9±11.8, p =0.002), the Euroscore was not different (22.0±14.0 vs 21.9±14.4, p =0.98). Balloon-expendable and Self-expendable devices were used in 67.6% and 32.4% of patients. Approaches were transfemoral in 75.4% of cases. These proportions were identical in DM and non-DM patients. Procedural success (96.6% vs 96.9%, p=0.63) was similar between DM and non-DM patients. The occurrence of an AR grade ≥ 2 was significantly lower in DM than in non-DM patients (11.0% vs 15.9%, p=0.001). By multivariate analysis, DM was independently associated with a lower risk of AR (p=0.01). 30-days (8.4% vs 9.8%) and 1-year (18.9% vs 19.0%) mortality was similar in DM and non-DM patients respectively (p=0.85), even after adjustment for other risk factors.
Conclusion: Despite the presence of more comorbities, DM does not negatively impact on the procedure and the long-term outcome of TAVR. Our results suggest that, unlike to conventional surgical aortic replacement, DM status should not be included in TAVR procedure related risk calculation.
- © 2012 by American Heart Association, Inc.