Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis
Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis
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DOI：
10.1186/s12933-019-0831-3
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发表时间：
2019-03-11
影响因子：
9.3
通讯作者：
Chopard, Romain
中科院分区：
文献类型：
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作者：
Besch, Guillaume;Pili-Floury, Sebastien;Chopard, Romain
背景血糖变异性与心脏手术后不良预后相关，但经导管主动脉瓣植入术后早期血糖变异性的预后价值尚不清楚。因此，本研究的目的是分析预后意义的术后血糖变异性后30天内，经导管主动脉瓣implantation.MethodsA事后分析的患者从我们的中心包括在法国和法国-2注册进行。通过计算经导管主动脉瓣植入后前20天内的平均每日血糖来评估术后血糖变异性。30天内的主要并发症死亡，中风，心肌梗死，急性心力衰竭，危及生命的心律失常。ResultsWe分析了160例患者（年龄（中位数[四分位数]=84 [80-88]岁;糖尿病（n）=41（26%）患者; Logistic欧洲评分=20 [12-32]）。平均每日血糖的中位数为4.3mmoll（-1）。术后30天内，血糖变异性最低四分位数的患者的严重并发症发生率为12%，从12%增加到26%，第二、第三和第四分位数分别为39%。在多变量分析中，血糖变异性与术后30天内主要并发症风险增加独立相关（比值比[95% CI]=1.83 [1.19-2.83]; p=0.006）。结论本研究表明，手术血糖变异性与经导管主动脉瓣植入后30天内主要并发症风险增加相关。注册临床试验注册号https：//www.clinicaltrials.gov/;标识符：NCT 02726958;日期：2016年4月4日
BackgroundGlycemic variability is associated with worse outcomes after cardiac surgery, but the prognosis value of early glycemic variability after transcatheter aortic valve implantation is not known. This study was therefore designed to analyze the prognosis significance of post-procedural glycemic variability within 30days after transcatheter aortic valve implantation.MethodsA post hoc analysis of patients from our center included in the FRANCE and FRANCE-2 registries was conducted. Post-procedural glycemic variability was assessed by calculating the mean daily blood glucose during the first 2days after transcatheter aortic valve implantation. Major complications within 30days were death, stroke, myocardial infarction, acute heart failure, and life-threatening cardiac arrhythmias.ResultsWe analyzed 160 patients (age (median [interquartile]=84 [80-88] years; diabetes mellitus (n)=41 (26%) patients; logistic Euroscore=20 [12-32]). The median value of mean daily blood glucose was 4.3mmoll(-1). The rate of major complications within 30days after procedure among patients with the lowest quartile of glycemic variability was 12%, increasing from 12 to 26%, and 39% in the second, third, and fourth quartiles, respectively. In multivariate analysis, glycemic variability was independently associated with an increased risk of major complications within 30days after the procedure (odds ratio [95% CI]=1.83 [1.19-2.83]; p=0.006).ConclusionsThis study showed that post-procedural glycemic variability was associated with an increased risk of major complications within 30days after transcatheter aortic valve implantation.Trial registration Clinical trial registration number https://www.clinicaltrials.gov/; identifier: NCT02726958; date: April 4th, 2016