Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox

Iglesias, Juan F.; Degrauwe, Sophie; Rigamonti, Fabio; Noble, Stéphane; Roffi, Marco

doi:10.1007/s11886-019-1091-2

Cited by 11 publications

(12 citation statements)

References 45 publications

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“…Generalizability might be limited in less experienced center with lower number of CTO-PCI cases. In fact, previous studies have indicated that patients in DM group were more likely to have complex clinical characteristics (9,13). However, in our study, baseline clinical and lesion characteristics were comparable between the diabetic and nondiabetic groups, which may be partially interpreted by these limitations above.…”

Section: Discussioncontrasting

confidence: 57%

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5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus

Wang

Yuan

Jia

et al. 2021

Front. Cardiovasc. Med.

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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.

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Section: Discussioncontrasting

confidence: 57%

“…Type 2 Diabetes mellitus (DM) is a well-established CAD risk equivalent and is associated with a greater atherosclerotic burden, such as multivessel disease, heavily calcified coronary lesions, diffuse and small vessel CAD (9,10). Previous studies have reported that patients with DM have an elevated incidence of CTO (∼30-40%) (11,12).…”

Section: Introductionmentioning

confidence: 99%

5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus

Wang

Yuan

Jia

et al. 2021

Front. Cardiovasc. Med.

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“…Our ndings can be explained by the following mechanisms. First, patients in DM group were more likely to have complex clinical characteristics, like lower LVEF, which had a detrimental effect on cardiac function [10,14]. Second, DM, as a greater risk factor for adverse cardiovascular outcomes, alters glucose and lipid metabolism and in uences vascular endothelial function and angiogenesis [28,29,33].…”

Section: Discussionmentioning

confidence: 99%

“…Type 2 Diabetes mellitus (DM) is a well-established CAD risk equivalent and is associated with a greater atherosclerotic burden, such as multivessel disease, heavily calci ed coronary lesions, diffuse and small vessel CAD [10,11]. Previous studies have reported that patients with DM have an elevated incidence of CTO (approximately 30-40%) [12,13].…”

Section: Introductionmentioning

confidence: 99%

Impact of Type 2 Diabetes on Five-year Clinical Outcomes Following Successful Percutaneous Coronary Intervention on Chronic Total Occlusions: a Propensity Matched Cohort Analysis

Wang¹,

Yuan²,

Jia³

et al. 2021

Preprint

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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 five-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 revealed a consistent effect on five-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. Further randomized studies are warranted to confirm these findings.

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“…72,73 Chronic total occlusions (CTO), defined as chronic (>3 months) complete coronary occlusion (TIMI 0 flow), are more common in diabetes. 74 CTOs are mostly treated by anginal medical therapy and CABG. CTO PCI is considered high risk and is performed in centers with high volume and expertise.…”

Section: Case-based Therapeutic Adjudicationmentioning

confidence: 99%

Coronary revascularization in patients with stable coronary disease and diabetes mellitus

Bhat

Yatsynovich

Sharma

2021

Diabetes and Vascular Disease Research

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Purpose of Study: Diabetes mellitus accelerates the development of atherosclerosis. Patients with diabetes mellitus have higher incidence and mortality rates from cardiovascular disease and undergo a disproportionately higher number of coronary interventions compared to the general population. Proper selection of treatment modalities is thus paramount. Treatment strategies include medical management and interventional approaches including coronary artery bypass graft (CABG) surgery and percutaneous coronary interventions (PCI). The purpose of this review is to assimilate emerging evidence comparing CABG to PCI in patients with diabetes and present an outlook on the latest advances in percutaneous interventions, in addition to the optimal medical therapies in patients with diabetes. Key Methods: A systematic search of PubMed, Web of Science and EMBASE was performed to identify prospective, randomized trials comparing outcomes of CABG and PCI, and also PCI with different generations of stents used in patients with diabetes. Additional review of bibliography of selected studies was also performed. Main Conclusions: Most of the trials discussed above demonstrate a survival advantage of CABG over PCI in patients with diabetes. However, recent advances in PCI technology are starting to challenge this narrative. Superior stent designs, use of specific drug-eluting stents, image-guided stent deployment, and the use of contemporary antiplatelet and lipid-lowering therapies are continuing to improve the PCI outcomes. Prospective data for such emerging interventional technologies in diabetes is however lacking currently and is the need of the hour.

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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox

Cited by 11 publications

References 45 publications

5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus

5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus

Impact of Type 2 Diabetes on Five-year Clinical Outcomes Following Successful Percutaneous Coronary Intervention on Chronic Total Occlusions: a Propensity Matched Cohort Analysis

Coronary revascularization in patients with stable coronary disease and diabetes mellitus

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