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Medical therapy vs early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic

Muhammad Shayan Khan1, Farhad Sami2, Hemindermeet Singh3

  • 1Internal Medicine, Mercy Saint Vincent Medical Centre, Toledo, OH 43608, United States. muhammadshayankhan1@gmail.com.

World Journal of Cardiology
|December 14, 2020
PubMed

Insights

Early revascularization (ER) shows a trend toward improved outcomes for diabetic patients with chronic total occlusions (CTO) compared to optimal medical therapy (OMT). ER may reduce mortality, though repeat myocardial infarction risk was similar between treatments.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetology

Background:

  • Management of chronic total occlusions (CTO) in diabetic patients presents challenges.
  • A shift towards early revascularization (ER) over optimal medical therapy (OMT) is observed.

Purpose of the Study:

  • To compare long-term clinical outcomes, morbidity, and mortality between OMT and ER in diabetic patients with CTOs.
  • To evaluate the effectiveness of ER versus OMT in managing diabetic CTOs.

Main Methods:

  • A systematic review and meta-analysis of published clinical trials (RCTs and observational studies) was conducted.
  • Pooled hazard ratios (HR) were computed using a random effects model.
  • Primary outcome was all-cause death; secondary outcomes included cardiac death, repeat revascularization, and myocardial infarction.

Main Results:

  • OMT was associated with a trend towards higher all-cause and cardiac mortality compared to ER (P=0.11 and P=0.07, respectively).
  • The risk of repeat myocardial infarction was similar between OMT and ER (HR: 0.97).
  • Patients on OMT had a significantly higher risk of repeat revascularization (HR: 1.62, P < 0.00001).

Conclusions:

  • Early revascularization (ER) demonstrates a trend towards improved outcomes in diabetic patients with CTOs compared to OMT.
  • Subgroup analysis of OMT versus percutaneous coronary intervention (PCI) reinforced these findings, showing higher mortality with OMT.
  • ER may be a beneficial strategy for managing diabetic CTOs, warranting further investigation.
Abstract

Keywords:
Chronic total occlusionsCoronary angiographyCoronary bypass graftsDiabetes mellitusMortalityPercutaneous coronary Intervention

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