Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014–2015)

Abstract

BackgroundType 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures.MethodsWe analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).ResultsWe identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR).ConclusionsT2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.Electronic supplementary materialThe online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.

Potentially preventable urinary tract infection in patients with type 2 diabetes – A hospital-based study

“…This is consistent with the findings of some studies (https://apurologia.pt/. A, 2008;Wilke et al, 2015;Hirji et al, 2012;Mazzi et al, 2017;de Decker et al, 2017;Mendez-Bailon et al, 2017;Rodríguez-Acelas et al, 2017;Shwartz et al, 1994) that have reported a high number of unnecessary hospitalizations. One study (Rosenthal et al, 2014) showed that marked differences exist in the use of medical resources, hospital beds, diagnostic exams, and medical treatments putting the patient at risk of infection.…”

“…Another study (de Decker et al, 2017) found that a high burden of comorbidities (stroke, heart failure, myocardial infarction, and functional cognitive impairment) increased the risk of hypoglycemic events in elderly patients (aged over 80 years) with diabetes. Mendez-Bailon et al (2017) studied 715 patients with diabetes admitted for cardiovascular diseases who underwent invasive cardiac procedures, and found that obesity (18%), arterial hypertension (67.3%), lipid abnormalities (45.8%), renal failure (14.07%), and intermittent claudication (1.65%) were risk factors for adverse events during hospitalization.…”

Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001–2015)

“…The results of the Virginia Cardiac Services Quality Initiative database showed that the prevalence of diabetes in 2002–2008 was 30.0%, 33.0% in 2009–2011 and 36.7% in 2012–2015 (p < 0.01) [ 24 ]. The expected aging of the Spanish population will surely result in an increase in the prevalence of T2DM patients among those undergoing SAVR in the next decade [ 14 ].…”

“…Several studies have assessed the impact of diabetes on the outcomes of SAVR and concluded that T2DM is one of the predictors of poor outcomes after SAVR [ 12 , 13 ]. Studies conducted in Spain and other countries have found that T2DM diabetic patients with aortic stenosis undergoing a valvular replacement procedure through SAVR or TAVR did not have higher mortality or complication rates than nondiabetic patients during hospitalization [ 14 , 15 ].…”

Correlation of Micro-Computed Tomography Assessment of Valvular Mineralisation with Histopathological and Immunohistochemical Features of Calcific Aortic Valve Disease

“…In fact, aortic valve replacement is the second most common cardiac procedure currently performed. Between 2014 and 2015, 18,000 of these operations were performed solely in Spain [3]. Research aimed at uncovering the pathological mechanisms behind aortic valve stenosis is, for these reasons, of vital necessity.…”