Clinical Impact of Glucose Levels on Patient Outcome after Transcatheter Aortic Valve Replacement.

Abstract

Background: Limited data are available for evaluating the effect of blood glucose on transcatheter aortic valve replacement (TAVR) outcomes in patients with diabetes. We aimed to assess the impact of glucose levels on short-term and long-term adverse outcomes in patients undergoing TAVR.

Methods and results: Data from severe aortic stenosis (AS) patients who underwent TAVR from 2010 to 2022 were collected retrospectively. In total, 615 patients were enrolled in the study: Among the total patient population, 43% had diabetes mellitus (DM), with a mean hemoglobin A1c (HbA1c) level of 7.4 ± 2.5. Within this cohort, 33% were classified as having uncontrolled diabetes, while 17% were considered well-controlled. Diabetic patients were younger (80.7 ± 6.8 vs. 82.0 ± 6.8 years, p = 0.001) and had more cardiovascular risk factors. No significant differences were found in outcomes between the two groups during the twelve-year follow-up. A multivariable logistic regression analysis was conducted on 270 DM patients to examine the impact of blood glucose levels and HbA1c on outcomes such as arrhythmia, stroke, and acute kidney injury (AKI). For arrhythmia, the odds ratio for HbA1c and blood glucose were 1.1039 (p = 0.23), and 0.998 (p = 0.76), indicating no significant associations. In stroke cases, HbA1c had an odds ratio of 1.194 (p = 0.36), while an odds ratio of 1.020 (p = 0.013) for blood glucose indicated a significant association. Notably, for AKI, the odds ratio for HbA1c was 2.304 (p = 0.02), indicating a significant link between higher HbA1c levels and increased AKI risk, with blood glucose levels trending toward significance (odds ratio = 1.0137, p = 0.061).

Conclusions: Diabetic status is a predictor of short-term outcomes following TAVR. Thus, these screening parameters should be included in risk assessment tools for TAVR candidates.