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Reperfusion for Proximal Left Circumflex Artery Chronic Total Occlusion Benefits Patients With Diabetes: A
Fei Yuan1, Maomao Liu2, Yunfeng Yan1
1Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-related Cardiovascular Diseases, Ministry of Education, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang, China.
Insights
For diabetic patients with stable left circumflex artery chronic total occlusion (LCX-CTO), successful revascularization (SR) showed no overall benefit. However, SR significantly reduced mortality in those with proximal LCX-CTO.
Area of Science:
- Cardiology
- Diabetology
- Interventional Cardiology
Background:
- Diabetes mellitus is associated with poor prognosis in patients with chronic total arterial occlusion.
- Limited data exists on the management of stable left circumflex artery chronic total occlusion (LCX-CTO) in diabetic patients.
Purpose of the Study:
- To evaluate the efficacy of successful revascularization (SR) versus medical therapy (MT) for stable LCX-CTO in patients with diabetes.
- To identify specific subgroups that may benefit from revascularization.
Main Methods:
- Retrospective analysis of 620 diabetic patients with stable LCX-CTO, stratified into SR (n=172) and MT (n=448) groups.
- Primary endpoint: major adverse cardiac events. Secondary analysis: cardiac and all-cause mortality.
- Propensity score-matched analyses and Cox regression, including subgroup analysis for proximal LCX-CTO.
Main Results:
- Overall, SR did not significantly reduce major adverse cardiac events compared to MT (aHR: 0.860, P=.558) after a median 44-month follow-up.
- This finding was consistent across other clinical endpoints.
- In the proximal LCX-CTO subgroup, SR significantly reduced cardiac mortality (aHR: 0.284) and showed a trend towards reduced all-cause mortality (aHR: 0.455).
Conclusions:
- Successful revascularization for stable LCX-CTO in diabetic patients does not offer overall clinical benefits.
- Revascularization should be considered for diabetic patients presenting with proximal LCX-CTO due to improved survival outcomes.
Abstract:
Diabetes with chronic total arterial occlusion carries a poor prognosis. Little is known about patients with diabetes and stable left circumflex artery (LCX) chronic total occlusion (LCX-CTO). We aimed to determine whether stable LCX-CTO should be recanalized in patients with diabetes. We analyzed patients with LCX-CTO, diabetes, and stable clinical symptoms (i.e., silent ischemia or symptomatic stable angina), who underwent successful revascularization (SR) or medical therapy (MT). The primary endpoint was major adverse cardiac events. Propensity score-matched analyses and Cox regression were performed. The proximal LCX-CTO subpopulation was analyzed. A stratified subgroup analysis was conducted for the primary endpoint. We enrolled 620 patients, stratified into MT (448, 72.26%) and SR groups (172, 27.74%). After a median 44-month follow-up, univariate and multivariable models showed that SR offered no clinical benefits regarding major adverse cardiac events (adjusted hazard ratio [aHR]: 0.860, 95% confidence interval [CI]: 0.520-1.423, P = .558). This was consistent for other clinical endpoints as well. However, in the subpopulation with proximal LCX-CTO, SR was superior in terms of cardiac (aHR: 0.284, 95% CI: 0.082-0.984) and all-cause mortality (aHR: 0.455, 95% CI: 0.167-1.239). Revascularization should be attempted in patients with diabetes who have proximal LCX-CTO.
