Type II Diabetes Mellitus is Associated with Faster Degeneration of Bioprosthetic Valve: Results from a Propensity Score-Matched Italian Multicenter Study
Background—The study was aimed at determining the impact of type II diabetes mellitus (DM) on postoperative bioprosthetic structural valve degeneration (SVD).
Methods and Results—Twelve Italian centers participated to the study. Patient data refer to bioprosthetic implants performed from November 1988 to December 2009 resulting in 6,184 patients (mean age, 71.3±5.4 years, 60.1% male) enrolled. Among them, 1,731 patients (27.9%) had type II DM. The propensity score-matching algorithm successfully matched 1,113 patients with type II DM with a same number of no-DM patients. The post-matching standard differences were lower than 0.1 for each of the covariates and 64.2% of DM patients were matched. The early (30-days) mortality was 7.8 % (n=87) vs. 2.9 % (n=33) in patients with or without type II DM (p<0.001), respectively. Seven-year freedom from valve deterioration was significantly lower in diabetics (73.2 % [71.6 to 85.5] vs. 95.4 % [83.9 to 100], p<0.001). In Cox regression models with robust SEs that accounted for the clustering of matched pairs DM was the strongest predictor of SVD (HR 2.39 [2.68-3.52]).When we allowed for interaction between type II DM and other key risk factors, it remained a significant predictor beyond any potentially associated variable.
Conclusions—Patients with type II DM undergoing bioprosthetic valve implantation are at high risk of early and long-term mortality as well as of SVD.
- Received February 10, 2011.
- Accepted December 15, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited