Clinical Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Background Diabetes mellitus is a well‐established risk factor for coronary artery disease (CAD) and is associated with complex coronary anatomy. While percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has evolved, outcomes in patients with diabetes remain poorly characterized. Objectives To evaluate procedural and clinical outcomes following CTO PCI in patients with and without diabetes mellitus using real‐world data from a high‐volume tertiary care center. Methods We retrospectively analyzed data from 495 patients who underwent CTO PCI at the Houston Methodist DeBakey Heart and Vascular Center between January 2018 and December 2023. Patients were divided for analysis by diabetes status. The primary endpoints included procedural success, all‐cause mortality at 1 year, and clinically driven target lesion revascularization (TLR). Secondary endpoints included target lesion failure (TLF) and in‐hospital complications. Results Among 495 patients undergoing CTO PCI, 246 (49.7%) had diabetes. Compared with nondiabetic patients, those with diabetes had significantly higher rates of chronic kidney disease (44.1% vs. 27.2%, p < 0.001), dialysis dependence (9.3% vs. 2.4%, p = 0.001), and prior CABG (29.8% vs. 18.9%, p = 0.005). Despite a higher prevalence of multivessel CTOs, reflecting greater anatomical complexity in patients with diabetes (43.8% vs. 23.9%, p = 0.012), procedural success rates were similarly high in both groups (84.6% vs. 81.6%, p = 0.37). At 1 year, all‐cause mortality and TLF rates were significantly higher in diabetic patients (HR = 2.03; 95% CI, 1.07–3.88; p = 0.03 and HR = 2.18; 95% CI, 1.31–3.62; p = 0.003, respectively). Procedural complexity was not an independent predictor of mortality or TLR among diabetic patients. Conclusion In this modern cohort, diabetes was associated with poorer long‐term outcomes after CTO PCI despite high procedural success rates. These findings should be interpreted in light of the study’s single‐center, retrospective design and potential residual confounding and appear to be largely driven by accompanying comorbidities, underscoring the need for individualized postprocedural management in this high‐risk population.