Chronic Total Occlusion
Five-year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients with Versus Without Type 2 Diabetes Mellitus
Peizhi Wang1, Deshan Yuan1, Ce Zhang1, Yuejin Yang1, Runlin Gao1, Bo Xu1, Jinqing Yuan2
Fuwai Hospital, China1, Fuwai hospital, China2
Diabetes mellitus (DM) is an independent risk factor for coronary artery disease (CAD) and often associated with more complex coronary lesions, like chronic total occlusions (CTOs). To date, there is a paucity of data on the benefit of successful percutaneous coronary intervention (PCI) for CTOs in diabetic and non-diabetic patients on long-term survival. In this study, we aimed to investigate the five-year cardiovascular survival for CTO-PCI patients with or without type 2 diabetes mellitus in a single-center cohort from China.
A total of 719 consecutive patients with 1 successful CTO-PCI at least throughout 2013 in our center were enrolled in the study and were grouped into diabetic patients (n=316, 43.9%) and non-diabetic patients(n=403, 56.1%). Baseline, angiographic and follow-up data were collected. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE), which consisted of cardiac death, recurrent myocardial infarction (MI), stroke and target vessel revascularization (TVR). The secondary endpoint was all-cause mortality. Propensity-score matching was also done to balance the baseline characteristics. A comparison of endpoints was done to evaluate long-term outcomes.
During a median follow-up of 1825 days, there was a significant difference between the two groups with respect to the prevalence of all-cause mortality (unadjusted hazard ratio [HR] 2.97, 95% confidence interval[CI] 1.22–7.23; P = 0.016) and MACCE (unadjusted HR 1.40, 95% CI 1.04-1.88; P =0.028). Through multivariate analysis, the rate of MACCE (adjusted HR 1.47, 95%CI 1.08-2.00; P = 0.013) was significantly higher in the diabetic group than in the non-diabetic group. However, in the propensity score matched population(289 pairs), there were no significant differences in the prevalence of MACCE (adjusted HR 1.27, 95% CI 0.92-1.75; P = 0.155) and all-cause mortality (adjusted HR 2.56,95% CI 0.91-7.24; P = 0.076) between groups.
For the treatment of successful CTO-PCI, non-diabetic patients may be related to better long-term survival benefit in terms of MACCE. Further randomized studies are warranted to confirm these findings.