Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis

Guillaume Besch, Sebastien Pili-Floury, Caroline Morel, Martine Gilard, Guillaume Flicoteaux, Lucie Salomon du Mont, Andrea Perrotti, Nicolas Meneveau, Sidney Chocron, Francois Schiele, Herve Le Breton, Emmanuel Samain, Romain Chopard, Guillaume Besch, Sebastien Pili-Floury, Caroline Morel, Martine Gilard, Guillaume Flicoteaux, Lucie Salomon du Mont, Andrea Perrotti, Nicolas Meneveau, Sidney Chocron, Francois Schiele, Herve Le Breton, Emmanuel Samain, Romain Chopard

Abstract

Background: Glycemic 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 30 days after transcatheter aortic valve implantation.

Methods: A 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 δ blood glucose during the first 2 days after transcatheter aortic valve implantation. Major complications within 30 days were death, stroke, myocardial infarction, acute heart failure, and life-threatening cardiac arrhythmias.

Results: We 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 δ blood glucose was 4.3 mmol l-1. The rate of major complications within 30 days 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 30 days after the procedure (odds ratio [95% CI] = 1.83 [1.19-2.83]; p = 0.006).

Conclusions: This study showed that post-procedural glycemic variability was associated with an increased risk of major complications within 30 days after transcatheter aortic valve implantation. Trial registration Clinical trial registration number https://www.clinicaltrials.gov/ ; identifier: NCT02726958; date: April 4th, 2016.

Keywords: Adverse events; Aortic disease; Blood glucose; Glucose variability; Transcatheter aortic valve implantation.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
Glycemic variability and insulin therapy adjustments. a Relationship between mean daily δ blood glucose and the number of adjustments made in the insulin infusion rate. b Relationship between mean daily δ blood glucose and the rate of insulin therapy adjustments

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