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

Abstract

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.

Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis

“…For non-DM patients, our present study reveals that successful CTO-PCI may not be associated with a better prognosis in the long term compared to CTO-MT alone, which is consistent with previous studies [ 23 , 27 ]. However, the reasons behind the phenomenon that only the DM group, instead of the non-DM group, could benefit from CTO revascularization remain unclear.…”

“…A total of 6 studies were included to compare successful CTO-PCI versus CTO-MT for clinical outcomes in DM patients [ 18 , 23 , 24 , 26 – 28 ], and 3 of 6 eligible studies reported the primary endpoint MACEs [ 18 , 23 , 27 ]. As revealed in Fig.…”

“…Four studies were included in this meta-analysis to compare successful CTO-PCI versus CTO-MT for clinical outcomes in non-DM patients [ 18 , 23 , 27 , 28 ]. As indicated in Fig.…”

“…Subsequently, we systematically compared the long-term prognosis of successful CTO-PCI in patients with versus without DM. A total of 9 studies were included to analyse this issue [ 18 – 23 , 25 , 27 , 28 ], and 4 of them reported a more than 3-year follow-up period[ 18 , 22 , 27 , 28 ]. As presented in the supplementary material (Additional File 1 : Fig.…”

Real-world outcomes of different treatment strategies in patients with diabetes and three-vessel coronary disease: a mean follow-up 6.3 years study from China

“…Our study showed that in patients with diabetes and TVD, PCI and CABG was associated with a lower risk of all-cause death and MACCE during follow-up, which suggested the importance of revascularization for these patients. Previous studies have shown that patients with diabetes have a worse prognosis [ 16 ] and benefits more from revascularization than non-diabetic patients [ 17 ]. However, it should be pointed out that patients in the MT group may have had different conditions, including a coronary artery with simple lesions (low SYNTAX scores) in which revascularization was not required; additionally, another condition is where a coronary artery with complex lesions (high SYNTAX scores) could not have revascularization performed.…”