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Glycemic Control Status and Long-Term Clinical Outcomes in Diabetic Chronic Total Occlusion Patients: An

Xuehui Zhang1, Maoxiao Nie1, Xue Chen2

  • 1Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Department of Cardiology, 2 Anzhen Road, Chaoyang District, Beijing 100029, China.

Journal of Interventional Cardiology
|May 12, 2021
PubMed

Insights

Good glycemic control (HbA1c < 7%) improves clinical outcomes for diabetic patients with chronic total occlusion (CTO), particularly reducing major adverse cardiovascular events (MACE) and repeat revascularization, especially in non-successful revascularization cases.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • The clinical benefits of optimal glycemic control in diabetic patients with chronic total occlusion (CTO) remain debated.
  • Diabetic CTO patients represent a significant challenge in cardiovascular medicine.

Purpose of the Study:

  • To investigate the association between glycemic control, specifically glycosylated hemoglobin A (HbA1c) levels, and clinical outcomes in diabetic CTO patients.
  • To determine if achieving an HbA1c below 7% impacts major adverse cardiovascular events (MACE) and revascularization rates.

Main Methods:

  • A cohort of 1029 diabetic CTO patients was analyzed.
  • Patients were categorized into HbA1c < 7% and HbA1c ≥ 7% groups based on one-year levels.
  • Kaplan-Meier analysis and Cox regression, with and without propensity score matching, were employed to compare outcomes including MACE, repeat revascularization, and target vessel revascularization (TVR).

Main Results:

  • After propensity score matching, the HbA1c < 7% group showed a trend towards superior MACE, primarily driven by reduced repeat revascularization.
  • Benefits were more pronounced in patients with non-successful CTO revascularization (CTO-NSR), including lower MACE, repeat revascularization, and TVR.
  • Improved outcomes in the HbA1c < 7% group were also noted in patients without chronic heart failure (CHF).

Conclusions:

  • An HbA1c level below 7% is associated with a reduced incidence of MACE in diabetic CTO patients, largely due to decreased repeat revascularization.
  • Good glycemic control positively impacts the clinical prognosis of diabetic CTO patients, especially those with CTO-NSR.
Abstract

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