Abstract
BackgroundDiabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM.MethodsAll relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis.ResultsEleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001).ConclusionsCompared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.
Highlights
Coronary chronic total occlusion (CTO), which is defined as a native coronary artery that is completely obstructed with Thrombolysis In Myocardial Infarction (TIMI) grade 0 flow for more than 3 months, is
Considerable evidence suggests that successful percutaneous coronary intervention (PCI) of CTO lesions is associated with a greater improvement of symptoms, quality of life, and left ventricular function compared with failed CTO-PCI or initial medical treatment (MT) alone [3,4,5]
A total of 9847 patients consisting of 4238 Diabetes mellitus (DM) patients and 5609 non-DM patients, which were recruited from 1998 to 2018 at different medical centres, were included in this meta-analysis
Summary
Coronary chronic total occlusion (CTO), which is defined as a native coronary artery that is completely obstructed with Thrombolysis In Myocardial Infarction (TIMI) grade 0 flow for more than 3 months, isZhu et al Cardiovasc Diabetol (2021) 20:29 observed in approximately 15–25% of patients undergoing diagnostic coronary angiography[1, 2]. Considerable evidence suggests that successful percutaneous coronary intervention (PCI) of CTO lesions is associated with a greater improvement of symptoms, quality of life, and left ventricular function compared with failed CTO-PCI or initial medical treatment (MT) alone [3,4,5]. DM is relatively common in coronary CTO patients (approximately 30–40%), which suggests that DM may be a risk factor for CTO [10, 11]. CTO patients with DM are more likely to have longer CTO lesions and higher Japanese-chronic total occlusion (J-CTO) scores [12]. Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
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