Impact of diabetes on clinical outcome of patients with heart failure undergoing ICD and CRT procedures : results from the German Device Registry

Aims: Diabetes mellitus (DM) has a negative impact on prognosis in patients with heart failure (HF).The role impact of DM inHF patients  with  implantable  cardioverter  defibrillator (ICD) or cardiac resynchronization therapy (CRT) devices  might differand remains unclear. The aim of our study was to investigate the impact of DM on periprocedural complications and clinicaloutcome in HF patients undergoing ICD or CRT implantation.

Methods and results: Within the German Device  Registry, data from 50 German centres were collected between January 2007 and February 2014. A retrospective analysis ofn=5329 patients undergoing ICD implantation was conducted. Patients’characteristics, procedural data, periprocedural  complications,  and  post-procedural  clinical outcome, including a compositeclinical endpoint of all-cause mortality, stroke, and myocardial infarction (MACCE), were analysed. Subgroup analysis were per-formed for ICD and CRT implantations. Median follow-up was 15.7 (12.9;20.0) and 16.2 (12.8;21.2) months in DM and non-DM patients. Of 5329 patients enrolled,n=1448 (27.2%) had a diagnosis of DM. Within the cohort, 94% of DM and 90%ofnon-DM patients had a diagnosis of HF. Patients with DM were older, had higher body mass index, and higher rate of cardio-vascular comorbidities compared with non-DM patients. Unadjusted and adjusted analyses revealed similar all-overintrahospital  periprocedural complication rates in both groups (4.1%vs 3.9%). Unadjusted Kaplan–Meier survival analysisshowed higher all-cause mortality after 1 year  (9.0% vs 6.3%; log-rankP=0.001) with higher MACCE rates (10.0% vs 7.3%;P<0.001) in the DM group versus non-DM patients. After multivariable adjustment for relevant covariates, the associationof DM to MACCE disappeared [HR1.11(0.89-1.38)].  Because chronic kidney disease (CKD) was clearly associated with in-creased 1 year MACCE  after multivariate adjustment [odds ratio (OR)2.11(1.68–2.64)], a subgroup analysis  was performedshowing a strong trend towards more perioperative complications in DM patients with CKD [OR2.16(0.9–5.21)], while no ef-fect of DM was observed in patients without CKD [OR0.73(0.42–1.28)].

Conclusions: The overall risk of periprocedural  complications and short-term (1year) clinical outcome in patients with DM and HF undergoing ICD or CRT  defibrillator (CRT-D) implantation was not increased. In contrast, CKD was associated withan increased risk of 1 year MACCE in HF patients undergoing ICD/CRT-D implantation.


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