Related Experiment Videos
Association Between Optimal Revascularization for Chronic Total Occlusion and Long-Term Outcomes in Patients With
Yanjun Song1,2, Zhangyu Lin1,2, Jining He1,2
1Cardiometabolic Medicine Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Background:
The relationship between optimal revascularization for chronic total occlusion (CTO) lesions and long-term clinical outcomes in patients with heart failure with or without type 2 diabetes (T2D) remains unclear. Therefore, this study aimed to investigate the association between optimal or nonoptimal CTO percutaneous coronary intervention (CTO-PCI) and long-term adverse clinical outcomes in patients with heart failure with or without T2D.
Methods:
This prospective cohort study included 1591 patients with heart failure who underwent CTO-PCI at Fuwai Hospital between January 2017 and December 2018. Patients were categorized based on CTO-PCI outcomes: failure, suboptimal revascularization, and optimal revascularization. The primary end point was a composite of cardiovascular death and target-vessel myocardial infarction (TVMI), whereas the secondary end point was a composite of all-cause death and myocardial infarction.
Results:
During a median follow-up of 3.3 years, 89 (5.6%) cases of cardiovascular death/TVMI occurred. Patients who received optimal revascularization had significantly lower risks of both cardiovascular death/TVMI (hazard ratio [HR], 0.45 [95% CI, 0.27-0.76]) and all-cause death/myocardial infarction (HR, 0.53 [95% CI, 0.33-0.86]) compared with those with CTO-PCI failure. Subgroup analysis showed that these associations were significant in patients with T2D (cardiovascular death/TVMI: HR, 0.25 [95% CI, 0.13-0.49]; all-cause death/myocardial infarction: HR, 0.28 [95% CI, 0.15-0.53]), but not in those without T2D (cardiovascular death/TVMI: HR, 0.87 [95% CI, 0.32-2.40]; all-cause death/myocardial infarction: HR, 1.06 [95% CI, 0.40-2.85]).
Conclusions:
Our findings suggest that optimal revascularization during CTO-PCI is associated with a lower risk of adverse cardiovascular events in patients with heart failure, particularly in those with T2D.
Related Concept Videos
Type II Diabetes II: Pathophysiology
Cardiomyopathy V: Interprofessional Care
Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Diabetic Retinopathy
Heart Failure V: Medical Management
Complications of Diabetes Mellitus