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The following is a summary of “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,” published in the March 2025 issue of the Cardiovascular Diabetology by Yu et al.

Effective glycemic control plays a crucial role in the management of patients undergoing transcatheter aortic valve replacement (TAVR), particularly those admitted to intensive care units (ICUs). Emerging glycemic indices, including the hemoglobin glycation index (HGI), stress hyperglycemia ratio (SHR), and glycemic variability (GV), offer a more comprehensive evaluation of glucose metabolism. However, their prognostic significance for both short- and long-term outcomes following TAVR remains insufficiently studied. This retrospective cohort study aimed to assess the association between these glycemic control metrics and mortality outcomes in ICU-admitted patients with TAVR. A total of 3,342 patients were identified from the Medical Information Mart for Intensive Care (MIMIC-IV) database and categorized into tertiles based on HGI, SHR, and GV levels. 

To analyze survival outcomes, Kaplan–Meier survival curves, Cox proportional hazards models, and restricted cubic splines (RCSs) were utilized. The primary endpoints were 30-day and 365-day all-cause mortality, and additional sensitivity analyses, subgroup assessments, and external validation were conducted to ensure the robustness of the findings. During follow-up, 1.6% and 6.9% of patients experienced mortality at 30 days and 365 days post-TAVR, respectively. After adjusting for confounding factors, a lower HGI was significantly associated with an increased risk of 365-day mortality ([HR] 1.48, 95% [CI] 1.05–2.09, P = 0.025). Conversely, a higher SHR was associated with an elevated risk of both 30-day (HR 2.92, 95% CI 1.32–6.45, P = 0.008) and 365-day mortality (HR 1.63, 95% CI 1.15–2.32, P = 0.006). 

Furthermore, GV demonstrated a non-linear relationship with long-term mortality risk, with 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) being predictive of increased 365-day mortality. These findings indicate that glycemic control metrics extend beyond conventional glucose measurements in predicting long-term outcomes in patients who were critically ill TAVR. The observed associations underscore the necessity for personalized glycemic management strategies tailored to this patient population. Further prospective studies are warranted to explore the potential of targeted interventions aimed at optimizing glycemic control in ICU-admitted patients with TAVR to improve survival outcomes.

Source: cardiab.biomedcentral.com/articles/10.1186/s12933-025-02684-x