Impact of diabetes on clinical outcomes of patients with hostile vascular access undergoing TAVI: insights from the HOSTILE registry
Year: 2026
Type: article
Abstract: Background Diabetes mellitus (DM) is associated with peripheral artery disease (PAD) and may increase the risk of vascular complications (VC) in patients with hostile femoral access undergoing TAVI. Aims To evaluate the association between DM, VC and clinical outcomes in this population. Methods and results The HOSTILE registry is an international study including consecutive patients undergoing TAVI with hostile femoral access, defined as severe bilateral iliofemoral PAD requiring percutaneous transluminal angioplasty or alternative access. Outcomes of patients with and without diabetes were compared and stratified by access strategy. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. The primary endpoint was VC of any vascular access. Secondary endpoints included major and minor VC and 30-day and one-year clinical outcomes. Among 1707 patients, 559 (32.7%) had diabetes. Diabetic patients had a higher burden of comorbidities and more severe PAD, represented by higher Hostile scores. Despite this, rates of VC were similar between diabetic and non-diabetic patients (IPTW-adjusted odds ratio 0.86, 95% confidence interval 0.68–1.08, P = .184), consistently across access strategies. 30-day and one-year all-cause mortality and ischemic outcomes did not differ between groups. DM was associated with a lower incidence of any bleeding at one year, driven by minor bleeding events. Conclusion In patients with hostile femoral anatomy undergoing TAVI, diabetes was associated with more severe PAD but not with an increased risk of VC, mortality, or ischemic events. These findings support the feasibility and safety of contemporary TAVI strategies in diabetic patients with complex peripheral anatomy.
Authors: Francesco Tartaglia, Tullio Palmerini, Francesco Saia, Antonio Giulio Bruno, Won-Keun Kim, Alessandro Iadanza, Ole De Backer, Francesco Burzotta, Nicolas M Van Mieghem, Thomas Pilgrim, Italo Porto, Tiziana Claudia Aranzulla, Max M Meertens, Michael Joner, Francesco Meucci, Stefan Toggweiler, Luca Testa, Sergio Berti, Matteo Montorfano, Daniel Braun, Fausto Castriota, Marco De Carlo, Marco Barbanti, Mohamed Abdel-Wahab, Georg Nickenig, Tommaso Piva, Pier Pasquale Leone, Azeem Latib, Giuseppe Tarantini, Ran Kornowski, Pablo Codner, Antonio L Bartorelli, Gregg W Stone, Giulio Stefanini
Institutions: Humanitas University, IRCCS Humanitas Research Hospital, University of Bologna, Kerckhoff Klinik, Azienda Ospedaliera Universitaria Senese, Copenhagen University Hospital, Rigshospitalet, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Erasmus MC, University of Bern, University Hospital of Bern, Ospedale Policlinico San Martino, A. O. Ordine Mauriziano di Torino, University Hospital Cologne, German Centre for Cardiovascular Research, Deutsches Herzzentrum München, Technical University of Munich, Azienda Ospedaliero-Universitaria Careggi, IRCCS Policlinico San Donato, Fondazione Toscana Gabriele Monasterio, IRCCS Ospedale San Raffaele, LMU Klinikum, Ludwig-Maximilians-Universität München, Azienda Ospedaliera Universitaria Pisana, University of Catania, Policlinico Universitario di Catania, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Leipzig University, University Hospital Bonn, Albert Einstein College of Medicine, Montefiore Medical Center, University of Padua, Rabin Medical Center, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7149328199