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Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Left Ventricular Systolic Dysfunction
Xi Wu1, Qin Li1, Mingxing Wu1
1Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China.
Insights
Patients with diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) had more adverse events. However, DM was not an independent predictor of major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetology
Background:
- Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are prevalent in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
- Understanding the clinical outcomes of these patients, particularly concerning the impact of DM, is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the two-year clinical outcomes of patients with LV systolic dysfunction who underwent successful PCI for CTO, comparing those with and without DM.
- To identify predictors of major adverse cardiovascular events (MACEs) in this patient cohort.
Main Methods:
- A cohort of 185 patients with LV systolic dysfunction and successful PCI for CTO was analyzed.
- Patients were divided into two groups: with DM and without DM.
- Clinical outcomes, including MACEs, all-cause mortality, cardiac death, and target vessel revascularization, were compared over a two-year follow-up period. Multivariable logistic regression was used to identify independent predictors of MACEs.
Main Results:
- Patients with DM (53.5%) had a higher incidence of comorbidities such as chronic kidney disease (CKD), elevated creatinine, higher HbA1c, and reduced eGFR.
- The DM group also presented with more multi-vessel disease, more lesions per patient, and higher J-CTO and SYNTAX scores.
- The DM group experienced significantly higher rates of MACEs (24.2% vs. 12.8%), all-cause mortality (9.1% vs. 3.5%), cardiac death (8.1% vs. 1.2%), and target vessel revascularization (18.2% vs. 7.1%) over two years. However, DM was not an independent predictor of MACEs (HR: 0.58; 95% CI: 0.32-1.03; p=0.260). Multi-vessel disease (HR: 1.69) and CKD (HR: 1.38) were associated with increased MACEs, while complete revascularization (HR: 0.36) was associated with reduced MACEs.
Conclusions:
- Patients with LV systolic dysfunction undergoing successful CTO-PCI and having DM showed a higher trend towards MACEs over two years.
- While DM is associated with worse outcomes, multi-vessel disease, CKD, and incomplete revascularization are significant predictors of MACEs in this population.
Background:
Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are common in patients who receive percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study aimed to investigate the clinical outcomes of LV systolic dysfunction patients who had successful PCI for CTO over two years, with or without DM.
Methods:
This cohort included 185 patients with LV systolic dysfunction undergoing successful PCI for CTO. A comparative analysis was performed on individual data and clinical outcomes among patients with and without DM after a two-year follow-up.
Results:
DM was identified in 99 (53.5%) patients who exhibited a higher incidence of chronic kidney disease (CKD), elevated serum creatinine levels, increased hemoglobin A1c, and reduced estimated glomerular filtration rates (p < 0.05). Patients with diabetes also experienced increased multi-vessel disease, a higher number of lesions per patient, as well as elevated multicenter chronic total occlusion registry in Japan (J-CTO) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (p < 0.05). During the two-year follow-up, the DM group showed a greater occurrence of major adverse cardiovascular events (MACEs) compared with the non-DM group (24.2% versus 12.8%, p < 0.001). The DM group also had higher rates of all-cause mortality (9.1% versus 3.5%, p < 0.002), cardiac death (8.1% versus 1.2%, p < 0.001), and target vessel revascularization (18.2% versus 7.1%, p < 0.001). Multivariable logistic regression analysis demonstrated that the presence of DM is not an independent predictor of MACEs (hazard ratio (HR): 0.58; 95% confidence interval (CI): 0.32 to 1.03; p = 0.260). Moreover, the multi-vessel disease (HR: 1.69; 95% CI: 1.21 to 2.36; p = 0.002), CKD (HR: 1.38; 95% CI: 1.08 to 1.78; p = 0.011) and complete revascularization (HR: 0.36; 95% CI: 0.14 to 0.88; p = 0.026) had a significant association with MACEs.
Conclusions:
In patients with LV systolic dysfunction who underwent successful CTO-PCI, those with diabetes exhibited a higher trend toward the incidence of MACEs over two years.
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