TY  - BOOK
AU  - Waksman, Ron
TI  - Transcatheter versus surgical aortic valve replacement in patients with diabetes and severe aortic stenosis at high risk for surgery: an analysis of the PARTNER Trial (Placement of Aortic Transcatheter Valve)
SN  - 0735-1097
PY  - 2014///
KW  - *Aortic Valve Stenosis/th [Therapy]
KW  - *Cardiac Catheterization/mt [Methods]
KW  - *Diabetes Mellitus, Type 2/di [Diagnosis]
KW  - *Heart Valve Prosthesis Implantation/mt [Methods]
KW  - *Hospital Mortality
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/co [Complications]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/su [Surgery]
KW  - Diabetes Mellitus, Type 2/co [Complications]
KW  - Diabetes Mellitus, Type 2/mo [Mortality]
KW  - Echocardiography, Doppler
KW  - Evaluation Studies as Topic
KW  - Female
KW  - Follow-Up Studies
KW  - Heart Valve Prosthesis
KW  - Heart Valve Prosthesis Implantation/mo [Mortality]
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - Postoperative Complications/mo [Mortality]
KW  - Postoperative Complications/pc [Prevention & Control]
KW  - Proportional Hazards Models
KW  - Risk Assessment
KW  - Severity of Illness Index
KW  - Sex Factors
KW  - Statistics, Nonparametric
KW  - Surgical Procedures, Minimally Invasive/mo [Mortality]
KW  - Surgical Procedures, Minimally Invasive/mt [Methods]
KW  - Survival Rate
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Comparative Study
KW  - Journal Article
KW  - Randomized Controlled Trial
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - BACKGROUND: Diabetes is associated with increased morbidity and mortality after surgical AVR for AS; CONCLUSIONS: Among patients with diabetes and severe symptomatic AS at high risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter AVR compared with surgical AVR. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894). Copyright  2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved; METHODS: Among treated patients with severe symptomatic AS at high risk for surgery in the PARTNER (Placement of Aortic Transcatheter Valve) trial, we examined outcomes stratified according to diabetes status of patients randomly assigned to receive transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year; OBJECTIVES: The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS); RESULTS: Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p = 0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (hazard ratio: 0.60 [95% confidence interval: 0.36 to 0.99]; p = 0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among nondiabetic patients, there was no significant difference in all-cause mortality at 1 year (p = 0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery; p = 0.88), but the rate of renal failure requiring dialysis >30 days was lower in the transcatheter group (0% vs. 6.1%; p = 0.003)
UR  - http://dx.doi.org/10.1016/j.jacc.2013.10.057
ER  -