Abstract
Background: Despite substantial improvement in chronic total occlusions (CTO) revascularization technique, the long-term clinical outcomes in diabetic patients with revascularized CTO remain controversial. Our study aimed to investigate the 5-year cardiovascular survival for patients with or without type 2 diabetes mellitus (DM) who underwent successful percutaneous coronary intervention (PCI) for CTO.Methods: Data of the current analysis derived from a large single-center, prospective and observational cohort study, including 10,724 patients who underwent PCI in 2013 at Fuwai Hospital. Baseline, angiographic and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which consisted of death, recurrent myocardial infarction (MI), stroke and target vessel revascularization (TVR). The secondary endpoint was all-cause mortality. Cox regression analysis and propensity-score matching was performed to balance the baseline confounders.Results: A total of 719 consecutive patients with ≥1 successful CTO-PCI were stratified into diabetic (n = 316, 43.9%) and non-diabetic (n = 403, 56.1%) group. During a median follow-up of 5 years, the risk of MACCE (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.08–2.00, P = 0.013) was significantly higher in the diabetic group than in the non-diabetic group, whereas the adjusted risk of all-cause mortality (HR 2.37, 95% CI 0.94–5.98, P = 0.068) was similar. In the propensity score matched population, there were no significant differences in the risk of MACCE (HR 1.27, 95% CI 0.92–1.75, P = 0.155) and all-cause mortality (HR 2.56, 95% CI 0.91–7.24, P = 0.076) between groups. Subgroup analysis and stratification analysis revealed consistent effects on 5-year MACCE across various subgroups.Conclusions: In patients who received successful CTO-PCI, non-diabetic patients were related to better long-term survival benefit in terms of MACCE. The risk of 5-year MACCE appeared to be similar in less-controlled and controlled diabetic patients after successful recanalization of CTO. Further randomized studies are warranted to confirm these findings.
Highlights
Chronic total occlusion (CTO) occurs in ∼15–25% of patients with coronary artery disease (CAD) undergoing diagnostic coronary angiography [1, 2]
Exclusion criteria included the following: [1] patients who underwent unsuccessful CTO-percutaneous coronary intervention (PCI) (n = 267); [2] patients lacking both hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) data (n = 9); [3] patients who were diagnosed as acute STEMI within 72 h before admission (n = 15)
Diabetes mellitus (DM) was defined as a FPG of at least 7.0 mmol/L, or glycated HA1c >6.5% or known diabetes, based on previous medical records of the patients and data of the therapeutic status based on the glucose-lowering therapy [17]
Summary
Chronic total occlusion (CTO) occurs in ∼15–25% of patients with coronary artery disease (CAD) undergoing diagnostic coronary angiography [1, 2]. CTO patients with DM are related to longer and more technically challenging occluded lesions, with lower success rates compared with that in nonDM [13]. To the best of our knowledge, no previous study has focused on longer term impact of successful recanalisation for CTO lesions in patients with vs without DM. We conducted a prospective, observational and realworld study to investigate 5-year clinical outcomes in type 2 diabetic and non-diabetic patients after successful CTO-PCI. Despite substantial improvement in chronic total occlusions (CTO) revascularization technique, the long-term clinical outcomes in diabetic patients with revascularized CTO remain controversial. Our study aimed to investigate the 5-year cardiovascular survival for patients with or without type 2 diabetes mellitus (DM) who underwent successful percutaneous coronary intervention (PCI) for CTO
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