Optimal revascularization during CTO-PCI was associated with a lower risk of cardiovascular death or target-vessel MI compared with CTO-PCI failure (HR 0.45; 95% CI 0.27-0.76).
Cohort (n=1,591)
No
Does optimal revascularization during CTO-PCI reduce cardiovascular death and target-vessel myocardial infarction in patients with heart failure with or without type 2 diabetes?
Optimal revascularization of chronic total occlusions in patients with heart failure is associated with reduced cardiovascular death and target-vessel MI, particularly in patients with comorbid type 2 diabetes.
Hazard Ratio: 0.45 (95% CI 0.27–0.76)
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.
Song et al. (Fri,) conducted a cohort in Heart failure with or without type 2 diabetes (n=1,591). Optimal revascularization vs. CTO-PCI failure was evaluated on Composite of cardiovascular death and target-vessel myocardial infarction (TVMI) (HR 0.45, 95% CI 0.27-0.76). Optimal revascularization during CTO-PCI was associated with a lower risk of cardiovascular death or target-vessel MI compared with CTO-PCI failure (HR 0.45; 95% CI 0.27-0.76).