Abstract
BackgroundTo assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).MethodsCoronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up.ResultsPoor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p = 0.008). At 13.5 ± 4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p = 0.034) and repeat revascularization (15.2% vs 25.5%, p = 0.026) was lower and the increase in LVEF (3.10% vs 1.80%, p = 0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p = 0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155,95% CI 1.290–3.599, p = 0.003) and repeat revascularization (HR 2.326, 95% CI 1.357–3.986, p = 0.002) in non-diabetic patients, but did not enter the model in those with T2DM.ConclusionsT2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.
Highlights
To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO)
Yang et al Cardiovasc Diabetol (2020) 19:59 of chronic totally occluded lesions accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass grafting is associated with a number of clinical benefits, such as anginal symptom relief, improved quality of life and ventricular function, and decreased mortality when compared to CTO patients whose recanalization was failed or those who received optimal medical treatment only [3,4,5,6,7]
Clinical and angiographic features Compared with non-diabetic patients, those with T2DM were more males in gender distribution, and had higher percentage of hypertension, multivessel disease and poorer coronary collaterals, and lower Left ventricular ejection fraction (LVEF) (Table 1)
Summary
To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Chronic total occlusion (CTO) occurs in 5–10% of patients with significant coronary artery disease undergoing routine coronary angiography, which is more common in those with diabetes mellitus [1, 2]. Both randomized trials and observational studies have demonstrated that successful revascularization. In stable coronary artery disease patients with CTO, while T2DM is strongly associated with reduced coronary collateral formation [24,25,26], few published studies have focused on the impact of coronary collaterals on clinical prognosis, especially for those with T2DM after CTO-PCI [6]
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