Influence of Total Coronary Occlusion on Clinical Outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)

Damluji, Abdulla; Pomenti, Sydney; Ramireddy, Archana; Al‐Damluji, Mohammed Salim; Alfonso, Carlos; Schob, Alan; Marso, Steven P.; Gilchrist, Ian C.; Moscucci, Mauro; Kandzari, David E.; Cohen, Mauricio G.

doi:10.1016/j.amjcard.2015.12.047

Cited by 19 publications

(19 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diabetes mellitus is associated with multi-, small vessel, diffuse atherosclerotic disease and higher rate of periprocedural MI, contrast induced nephropathy which may impact on procedure success rate and complications that consequently affect long term outcomes. However, in Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, CTO didn't increase periprocedural mortality in diabetes patients treated either by PCI or bypass surgery but it was associated with poor prognosis if left untreated [31,32]. In our study, technical success rate of revascularization of CTO in diabetics was not different as compare to that of non-diabetics with similar peri-procedural complications.…”

Section: Discussioncontrasting

confidence: 48%

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

Tsai

Huang

Teng

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background: Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. Methods and results: From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1-10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349-0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156-0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095-0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn't improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125-0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142-0.851, P: 0.021). Conclusions: Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population.

show abstract

Section: Discussioncontrasting

confidence: 48%

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

Tsai

Huang

Teng

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…However, all of the above studies focused on the entire CTO population. Diabetic status was associated with fast atherosclerosis progression and poor clinical outcomes [18, 29–33]. Under such a special situation, whether revascularization should be performed is unknown.…”

Section: Discussionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. Methods We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. Results A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269–0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278–0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. Conclusions For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database Electronic supplementary material The online version of this article (10.1186/s12933-019-0911-4) contains supplementary material, which is available to authorized users.

show abstract

“…The Bypass Angioplasty Revascularization Investigation 2 Diabetes trial showed a higher mortality rate observed in CTO patients who were treated medically and the authors suggested that the presence of CTO might not always influence total death rate following revascularization in these patients. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Outcomes of percutaneous coronary intervention in patients with coronary chronic total occlusions with versus without type 2 diabetes mellitus

Wang

Líu²,

Ding³

2017

Medicine

View full text Add to dashboard Cite

Background:Nowadays, due to advanced techniques and well-trained interventionists in catheter labs, new scientific research has shown percutaneous coronary intervention (PCI) to be a safe treatment procedure in patients with chronic total occlusion (CTO). However, no study has systematically compared PCI outcomes in CTO patients with versus without type 2 diabetes mellitus (T2DM). Therefore, through this meta-analysis we aimed to systematically solve this issue.Methods:Between September 2016 and June 2017, the Cochrane Database of Randomized Trials, EMBASE, and MEDLINE databases were carefully searched for publications comparing PCI outcomes in CTO patients with versus without T2DM. Long-term (≥1 year) adverse clinical outcomes were considered the endpoints. Discontinuous data were analyzed by RevMan 5.3 whereby odds ratios (OR) and 95% confidence intervals (CIs) were the statistical parameters.Results:This analysis consisted of 1 randomized trial and 6 observational studies with a total number of 4571 patients with CTO (1915 patients with T2DM and 2656 patients without T2DM). Patients’ enrollment was between the years 1998 and 2015.During this long-term follow-up (≥1 year), mortality was significantly higher in CTO patients with T2DM (OR: 1.56, 95% CI: 1.05–2.31; P = .03, I2 = 0%). Major adverse cardiac events (MACEs) and repeated revascularization were also significantly higher in patients with T2DM (OR: 1.30, 95% CI: 1.06–1.58; P = .01, I2 = 10%) and (OR: 1.30, 95% CI: 1.06–1.59; P = .01, I2 = 36%) respectively. However, myocardial infarction was not significantly different (OR: 1.01, 95% CI: 0.61–1.67; P = .96, I2 = 26%).Conclusion:During this longer follow-up period post-PCI, mortality, MACEs and repeated revascularization in CTO patients with T2DM were significantly higher compared with similar patients without T2DM. Nevertheless, whether this hypothesis is relevant or not should be confirmed in larger trials.

show abstract

Influence of Total Coronary Occlusion on Clinical Outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)

Cited by 19 publications

References 16 publications

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Outcomes of percutaneous coronary intervention in patients with coronary chronic total occlusions with versus without type 2 diabetes mellitus

Contact Info

Product

Resources

About