Erschienen in:
25.06.2018 | Original Paper
Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement
verfasst von:
Axel Linke, Florian Schlotter, Stephan Haussig, Felix J. Woitek, Georg Stachel, Jennifer Adam, Robert Höllriegel, Anna Lindner, Friedrich W. Mohr, Gerhard Schuler, Philipp Kiefer, Sergey Leontyev, Holger Thiele, Michael A. Borger, David Holzhey, Norman Mangner
Erschienen in:
Clinical Research in Cardiology
|
Ausgabe 1/2019
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Abstract
Background
Diabetes mellitus (DM) is a risk factor for cardiovascular disease. However, its effect on procedural and follow-up performance after transcatheter aortic valve replacement (TAVR) remains controversial.
Methods and results
We performed an observational study of all consecutive patients treated with a transfemoral TAVR in a single-center cohort (n = 1818). All patients were stratified by diabetes status and gender. All-cause 3-year mortality was the primary endpoint. Male patients with DM were identified to have substantially increased 3-year mortality [125/314 (39.8%)] compared to males without DM [142/478 (29.7%), p < 0.01]. Male patients with DM had significantly higher 3-year mortality in comparison to female patients with (p < 0.01) or without DM (p < 0.01). There was no difference in 3-year mortality for female patients with [135/465 (29.0%)] and without DM [151/554 (27.3%); p = 0.70]. This increase in mortality in male DM patients was triggered by both cardiovascular and non-cardiovascular mortality. Furthermore, DM served as an independent predictor of 3-year mortality after TAVR selectively only in men. The interaction between male gender and diabetes mellitus was identified as an independent predictor of 3-year mortality [HR 1.88 (1.25; 2.82); p < 0.01]. DM did not affect 30-day mortality for the overall cohort and for males.
Conclusion
Males with DM are a high-risk subgroup of patients after TAVR and require close medical attention including aggressive therapy of modifiable risk factors. Intensified diabetes management may improve long-term survival after TAVR.