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Percutaneous Coronary Intervention Offers Clinical Benefits to Diabetic Patients With Stable Chronic Total Occlusion

Yunfeng Yan1, Fei Yuan1, Xinmin Liu1

  • 1Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China.

Angiology
|February 22, 2023
PubMed

Insights

Percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers survival benefits over medical therapy. Successful CTO-PCI significantly reduces cardiac and all-cause death, regardless of patient characteristics.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetology

Background:

  • Diabetic patients with chronic total occlusion (CTO) present unique challenges for treatment.
  • The comparative effectiveness of percutaneous coronary intervention (CTO-PCI) versus medical therapy (CTO-MT) for CTO in diabetics remains unclear.

Purpose of the Study:

  • To evaluate the benefits of CTO-PCI compared to initial CTO-MT in diabetic patients with stable angina or silent ischemia.
  • To identify factors influencing treatment assignment and outcomes in this patient cohort.

Main Methods:

  • A cohort of 1605 diabetic patients with one CTO was analyzed.
  • Patients were assigned to either CTO-PCI (n=1044) or initial CTO-MT (n=561).
  • Outcomes, including major adverse cardiovascular events, cardiac death, and all-cause death, were assessed at a median follow-up of 44 months.

Main Results:

  • CTO-PCI demonstrated a trend towards superiority in major adverse cardiovascular events (aHR: .81) compared to CTO-MT.
  • CTO-PCI was significantly superior in reducing cardiac death (aHR: .58) and all-cause death (aHR: .678).
  • Benefits of CTO-PCI were primarily linked to successful procedures and were consistent across various clinical and angiographic characteristics.

Conclusions:

  • For diabetic patients with stable CTO, CTO-PCI, particularly successful procedures, provides significant survival benefits over initial medical therapy.
  • These survival advantages are robust and not influenced by patient-specific clinical or angiographic factors.

Keywords:
chronic total occlusiondiabetesmedical therapypercutaneous coronary intervention

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