Impact of glycemic control metrics on short- and long-term mortality in transcatheter aortic valve replacement patients: a retrospective cohort study from the MIMIC-IV database.

Abstract

Background: Glycemic control is critical for managing transcatheter aortic valve replacement (TAVR) patients, especially those in intensive care units (ICUs). Emerging metrics such as the hemoglobin glycation index (HGI), stress hyperglycemia ratio (SHR), and glycemic variability (GV) offer advanced insights into glucose metabolism. However, their prognostic implications for short- and long-term outcomes post-TAVR remain underexplored.

Methods: This retrospective cohort study analyzed 3342 ICU-admitted TAVR patients via the MIMIC-IV database. Patients were stratified into tertiles for HGI, SHR, and GV levels. Survival analyses, including Kaplan‒Meier curves, Cox proportional hazards models and restricted cubic splines (RCSs), were used to assess associations between glycemic control metrics and 30-day and 365-day all-cause mortality in these patients. Sensitivity analyses, subgroup assessments, and external validation were also performed to verify the study findings.

Results: During follow-up, 1.6% and 6.9% of patients experienced 30-day and 365-day mortality after TAVR, respectively. In the fully adjusted cox regression model, lower HGI (HR 1.48, 95% CI 1.05-2.09, P = 0.025) and higher SHR (HR 1.63, 95% CI 1.15-2.32, P = 0.006) were most significantly associated with an increased risk of 365-day mortality. Higher SHR was also significantly associated with an increased risk of 30-day mortality in patients (HR 2.92, 95% CI 1.32-6.45, P = 0.008). Both lower (HR 0.59, 95% CI 0.38-0.92, P = 0.019) and higher GV levels (HR 1.43, 95% CI 1.06-1.93, P = 0.020) were associated with the risk of 365-day mortality.

Conclusions: In critically ill TAVR patients, glycemic control metrics are closely associated with long-term all-cause mortality. The HGI, SHR, and GV provide prognostic insights into clinical outcomes that surpass conventional glucose measurements. These findings highlight the importance of personalized glycemic management strategies in improving TAVR patient outcomes.