Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry

Abstract

Aim To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. Methods We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. Results The participants' mean ± SD age was 66±10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P=0.006), and to have had previous heart failure (35 vs 22%; P=0.0001) and peripheral arterial disease (19 vs 13%; P=0.002). They also had a higher BMI (31±6 kg/m2 vs 29±6 kg/m2; P=0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P=0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P=0.66), retrograde (30 vs 28%; P=0.66) and antegrade dissection re-entry (24 vs 25%; P=0.66). Technical (91 vs 90%; P=0.80) and procedural (89 vs 89%; P=0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P=0.61). Conclusions In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes.

Comparison of long-term clinical outcomes of percutaneous coronary intervention for chronic total occlusion between patients with and without diabetes mellitus: a single-center retrospective observational study

“…A notable finding of the present study was that the clinical outcomes did not differ significantly between participants with DM and those without DM. Our observations are consistent with those of 2 previous studies (32,39), which implies that patients with CTO and DM can achieve the same benefit from PCI as those without DM. Nevertheless, prospective, randomized studies are needed to directly compare the clinical benefits of PCI for CTO between patients with DM and those without.…”

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

“…Finally, only 7 studies (1 randomized trial [ 7 ] and 6 observational studies) [ 8 – 13 ] were included in this analysis as shown in Fig. 1 .…”

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

“…According to previous studies, approximately 40% of the patients undergoing CTO-PCI also had DM [ 10 , 29 ]. Although CTO lesions are more complex in DM patients, 2 recent large CTO studies, in which contemporary dedicated equipment and skills, including hybrid algorithms, have been applied, reported that procedural success and the prevalence of periprocedural complications were acceptable and comparable in patients with versus without DM [ 12 , 30 ]. However, the long-term prognosis of CTO revascularization with PCI in DM patients remains controversial, and few RCTs have been designed to assess it specifically.…”