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Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery

Christopher B Overgaard1, Vladimír Džavík, Christopher E Buller

  • 1Peter Munk Cardiac Centre, University Heath Network, Toronto, Ontario, Canada.

International Journal of Cardiology
|April 16, 2013
PubMed

Insights

For diabetic patients with a totally occluded artery after heart attack, percutaneous coronary intervention (PCI) offers no benefit over optimal medical therapy alone. Diabetes increases cardiovascular risk, but PCI does not improve outcomes in this high-risk group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetology

Background:

  • Percutaneous coronary intervention (PCI) for totally occluded arteries post-myocardial infarction (MI) in stable patients does not reduce adverse events.
  • Diabetic patients face elevated cardiovascular risk, necessitating specific outcome analysis for PCI versus medical therapy.

Purpose of the Study:

  • To evaluate the 7-year clinical outcomes of diabetic patients undergoing PCI versus optimal medical therapy (MED) after MI.
  • To compare outcomes between diabetic and non-diabetic patients in the Occluded Artery Trial (OAT).

Main Methods:

  • Analysis of 454 diabetic patients randomized to PCI or MED in the OAT.
  • Assessment of the composite primary endpoint: death, re-MI, or NYHA class IV heart failure over 7 years.
  • Comparison of outcomes between diabetic and non-diabetic cohorts and by treatment strategy.

Main Results:

  • Diabetic patients had a significantly higher 7-year primary event rate (35.0%) compared to non-diabetics (19.4%).
  • Diabetes was an independent predictor of adverse outcomes, including recurrent MI, heart failure, and death.
  • No significant difference in primary event rates between PCI (35.3%) and MED (34.5%) for diabetic patients (p=0.19).

Conclusions:

  • PCI does not improve clinical outcomes for diabetic patients with a totally occluded infarct-related artery in the sub-acute phase post-MI.
  • Despite higher risks, PCI is not indicated in stable diabetic patients with occluded arteries after MI.
  • Optimal medical therapy alone is comparable to PCI in this specific high-risk diabetic population.
Abstract

Keywords:
DiabetesOccluded arteryOpen artery hypothesisPercutaneous coronary intervention

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