Unravelling the "diabetes discrepancy": The presence of chronic complications is a hallmark of worse short-term outcomes in patients with diabetes mellitus after transcatheter aortic valve replacement.

Background: In transcatheter aortic valve replacement (TAVR), there is a notable "diabetes discrepancy", where worse/better/similar outcomes were all found for patients with diabetes mellitus (DM). Such divergent findings pose a challenge for clinicians to accurately assess the risks for DM patients undergoing TAVR. We hypothesized the presence of chronic complications could be linked to worse post-TAVR outcomes in DM patients. Therefore, this study aimed to compare the short-term outcomes of TAVR between DM patients with chronic complications (DM-CC), those without complications (DM-NCC), and non-diabetic individuals (non-DM).

Methods: Patients who underwent TAVR were identified in National Inpatient Sample database from Q4 2015 to 2020. In-hospital post-TAVR outcomes were compared between DM-CC, DM-NCC, and non-DM. Multivariable logistic regression was used to adjust for demographics, socioeconomic status, primary payer status, hospital characteristics, transfer status, admission status, comorbidities and relevant diagnoses, and access site.

Results: There were 22,168 DM patients (9388 DM-CC and 12,780 DM-NCC) and 36,682 non-DM patients underwent TAVR. DM-CC were found to have worse outcomes than non-DM, which included adjusted risks of cardiac, neurological, pulmonary, and renal system complications, wound complications, hemorrhage, longer length of stay (LOS), and higher hospital charges. However, compared to non-DM, DM-NCC had lower in-hospital mortality, cardiac and renal system complications, infection, and superficial wound complications, as well as shorter LOS.

Conclusions: The presence of diabetic chronic complications could be a hallmark for worse short-term outcomes after TVAR, which may unravel the long-debated "diabetes discrepancy" in TAVR and provide insights into preoperative risk stratification for DM patients.