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Published on: May 21, 2017
Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement
Eilon Ram1,2, Alexander Kogan3,4,5, Shany Levin3
1Department of Cardiac Surgery, Tel Aviv University, Tel Aviv, Israel. eilon.ram@sheba.health.gov.il.
Insights
Type 2 diabetes mellitus (DM) significantly increases long-term mortality risk following aortic valve replacement (AVR) surgery. Insulin treatment further elevates this risk, highlighting the need for careful management in diabetic patients undergoing AVR.
Area of Science:
- Cardiology
- Diabetology
- Surgical Outcomes
Background:
- Diabetes mellitus (DM) is linked to increased cardiovascular disease risk and aortic stenosis.
- Previous studies on DM's impact on aortic valve replacement (AVR) outcomes show conflicting results.
- Type 2 DM's specific effect on mortality after isolated AVR requires further investigation.
Purpose of the Study:
- To compare short-, intermediate-, and long-term mortality in patients with and without type 2 DM undergoing isolated AVR.
- To identify the impact of type 2 DM on mortality outcomes after AVR.
- To assess the influence of insulin treatment within diabetic patients on AVR outcomes.
Main Methods:
- Observational study including 1053 patients undergoing isolated AVR between 2004-2018.
- Comparison of mortality rates between 346 patients with type 2 DM and 67% non-DM patients.
- Evaluation of short-term (in-hospital), intermediate (1- and 3-year), and long-term (5- and 10-year) mortality.
Main Results:
- Short-term mortality was similar between DM and non-DM groups (3.5% vs. 2.5%).
- Long-term mortality was significantly higher in the DM group (19.4% vs. 12.9% at 5 years; 30.3% vs. 23.5% at 10 years).
- Insulin-treated DM patients showed higher long-term mortality (36.4% vs. 29.2%) and DM with insulin treatment were predictors for late mortality.
Conclusions:
- Type 2 DM is an independent predictor of long-term mortality after isolated AVR.
- Insulin treatment in diabetic patients undergoing AVR is associated with increased long-term mortality.
- These findings emphasize the importance of managing diabetes and its treatment in patients undergoing AVR.
Background:
Diabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR.
Methods:
We performed an observational study in a large tertiary medical center over a 14-year period (2004-2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months.
Results:
Short-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03-1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05-2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis.
Conclusions:
Type 2 DM is an independent predictor for long-term mortality after isolated AVR surgery.
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