Impact of diabetes mellitus on short term vascular complications after TAVR: Results from the BRAVO-3 randomized trial. (15th December 2019)

• Record Type: Journal Article
• Authors: Goel, Ridhima; Power, David; Tchetche, Didier; Chandiramani, Rishi; Guedeney, Paul; Claessen, Bimmer E.; Sartori, Samantha; Cao, Davide; Meneveau, Nicolas; Tron, Christophe; Dumonteil, Nicolas; Widder, Julian D.; Hengstenberg, Christian; Ferrari, Markus; Violini, Roberto; Stella, Pieter R.; Jeger, Raban; Anthopoulos, Prodromos; Deliargyris, Efthymios N.; Mehran, Roxana; Dangas, George D.
• Is Part Of: International journal of cardiology. Volume 297(2019)
• Page Start: 22
• Page End: 29
• Publication Date: 2019-12-15
• Subjects: TAVR -- Diabetes mellitus -- Complications -- BRAVO-3; AKI Acute Kidney Injury -- AS Aortic Stenosis -- BRAVO-3 Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement trial -- DM Diabetes Mellitus -- IDDM Insulin Dependent Diabetes Mellitus -- MACE Major Adverse Cardiac Events -- MI Myocardial Infarction -- NIDDM Non-Insulin Dependent Diabetes Mellitus -- TAVR Transcatheter Aortic Valvular Replacement; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.09.063
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: The impact of diabetes mellitus (DM) on clinical outcomes after transcatheter aortic valve replacement (TAVR) remains unclear. The aim of this study was to investigate the impact of DM on short-term clinical outcomes after TAVR in a large randomized trial population. Methods and results: BRAVO-3 trial randomized 802 patients undergoing trans -femoral TAVR to procedural anticoagulation with bivalirudin or unfractionated heparin. The study population was divided according to the presence of DM, and further stratified according to the use of insulin. Net adverse cardiovascular outcomes (NACE – death, myocardial infarction (MI), stroke or major bleeding by Bleeding Academic Research Consortium (BARC) type 3b or above) was the primary outcome in-hospital and at 30-days. Of the total 802 randomized patients, 239 (30%) had DM at baseline, with 87 (36%) being treated with insulin. At 30-days, DM patients experienced numerically higher rates of net adverse cardiovascular events (16.3% vs. 14.4%, p = 0.48) and acute kidney injury (19.7% vs. 15.1%, p = 0.11), while non-DM (NDM) patients had numerically higher rates of cerebrovascular accidents (3.6% vs. 1.7%, p = 0.22). After multivariable adjustment, DM patients had higher odds of vascular complications at 30-days (OR 1.57, p = 0.03) and life-threatening bleeding both in-hospital (OR 1.50, p = 0.046) and at 30-days (OR 1.50, p = 0.03) with the excess overall risk primarily attributed to the higher rates observed among non-insulin dependent DM patients. Conclusions: Patients with DM had higher adjusted odds of vascular and bleeding complications up to 30-days post-TAVR. Overall, there was no significant association between DM and early mortality following TAVR. Highlights: DM patients undergoing TAVR are at higher risk of life-threatening bleeding. DM patients are also at higher risk of major vascular complication after TAVR. Insulin dependent DM doesn't increase risk for short-term adverse events after TAVR. DM does not increase risk of short-term mortality following trans -femoral TAVR.