ABSTRACT
BACKGROUND: Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information. METHODS: We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose < 7 mmol/L. RESULTS: Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022). CONCLUSIONS: Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.
Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus/etiology , Myocardial Ischemia/therapy , Percutaneous Coronary Intervention/adverse effects , Prediabetic State/etiology , Aged , Biomarkers/blood , Chi-Square Distribution , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Fasting/blood , Female , Glucose Tolerance Test , Heart Failure/etiology , Heart Failure/therapy , Humans , Logistic Models , Longitudinal Studies , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Myocardial Ischemia/diagnosis , Odds Ratio , Patient Readmission , Prediabetic State/blood , Prediabetic State/diagnosis , Predictive Value of Tests , Prospective Studies , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Aortic Valve Stenosis/mortality , Cardiac Catheterization/mortality , Heart Valve Prosthesis Implantation/mortality , Heart Valve Prosthesis , Prosthesis Failure , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Cardiac Catheterization/adverse effects , Female , Follow-Up Studies , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Humans , Incidence , Male , Prosthesis Failure/adverse effects , Survival Rate/trends , Treatment OutcomeSubject(s)
Cardiac Resynchronization Therapy , Cardiomyopathy, Dilated/therapy , Ventricular Function, Left , Aged , Female , Humans , Male , Middle Aged , Prospective StudiesSubject(s)
Aortic Valve Stenosis/therapy , Cardiac Catheterization , Heart Valve Prosthesis Implantation , Severity of Illness Index , Ventricular Dysfunction, Left/therapy , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization/methods , Female , Follow-Up Studies , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/methods , Humans , Male , Stroke Volume/physiology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathologyABSTRACT
BACKGROUND: Few data exist on the clinical impact of transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis and a high surgical risk. The aim of this study was to determine the survival and the factors predicting mortality after 30 days post-TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN). METHODS: From April 2008 to October 2010, the CoreValve prosthesis (Medtronic) was implanted in 133 consecutive high-risk surgical patients with symptomatic severe aortic stenosis. RESULTS: The mean age was 79.5 ± 6.7 years. The logistic European System for Cardiac Operative Risk Evaluation was 21.5% ± 14%. The implantation success rate was 97.7%. In-hospital mortality was 4.5%, and the combined end point of death, vascular complications, myocardial infarction, or stroke had a rate of 9%. Survival at 12 and 24 months was 84.5% and 79%, respectively, after a mean follow-up of 11.3 ± 8 months. The New York Heart Association functional class improved from 3.3 ± 0.5 to 1.18 ± 0.4 and remained stable at 1 year. A high Charlson index (hazard ratio [HR] 1.44, 95% CI 1.09-1.89, P < .01) and a worse Karnofsky score before the procedure (HR 0.95, 95% CI 0.92-0.99, P = .021) were predictors of mortality after 30 days. CONCLUSIONS: Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient.
Subject(s)
Aortic Valve Stenosis/mortality , Cardiac Catheterization/methods , Heart Valve Prosthesis , Aged , Aortic Valve Stenosis/surgery , Female , Hospital Mortality/trends , Humans , Male , Prognosis , Prosthesis Design , Risk Factors , Severity of Illness Index , Spain/epidemiology , Survival Rate/trends , Time Factors , Treatment OutcomeSubject(s)
Cardiomyopathy, Dilated/pathology , Echocardiography/instrumentation , Mitral Valve Insufficiency/pathology , Papillary Muscles/pathology , Cardiac Resynchronization Therapy , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/therapy , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/therapy , Papillary Muscles/diagnostic imagingABSTRACT
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