Key result
PCI for chronic total occlusion reduced cardiac death risk compared to medical therapy in non-diabetic patients (MT vs PCI HR 2.54; 95% CI 1.19-5.42; p=0.02), but not in diabetic patients.
Why the study?
Does percutaneous coronary intervention reduce cardiac death in patients with coronary chronic total occlusion compared to medical therapy, and does this effect vary by diabetes status?
Cohort (n=1,547)
No
Does percutaneous coronary intervention reduce cardiac death in patients with coronary chronic total occlusion compared to medical therapy, and does this effect vary by diabetes status?
Hazard Ratio: 2.54 (95% CI 1.19–5.42)
p-value: p=0.02
Percutaneous coronary intervention for chronic total occlusion is associated with reduced long-term cardiac mortality in non-diabetic patients, but this benefit is not observed in patients with diabetes.
PCI may lower cardiac death in non-diabetic CTO patients; leaves open diabetes interaction pending randomized confirmation.
AIMS: The aim of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) treated with percutaneous coronary intervention (PCI) versus medical therapy (MT) according to the presence of diabetes mellitus. METHODS AND RESULTS: A total of 845 patients without diabetes and 702 patients with diabetes were included from the Samsung Medical Center CTO registry. The inverse probability of treatment weighting (IPTW) method was used to adjust for confounding factors. The primary outcome was cardiac death. Median follow-up duration was 46 (interquartile range: 23-71) months. Among the non-diabetes group, patients in the MT group had a higher rate of cardiac death (adjusted hazard ratio [HR] 2.54, 95% confidence interval [CI]: 1.19-5.42, p=0.02) compared to those in the PCI group. For patients with diabetes, there was no significant difference between the two groups in the rate of cardiac death (adjusted HR 1.09, 95% CI: 0.62-1.90, p=0.77). There was a significant interaction between diabetes and cardiac death (interaction p=0.03). After using IPTW methods, a similar result was observed (interaction p<0.001). CONCLUSIONS: For the treatment of CTO, PCI may reduce the risk of cardiac mortality in non-diabetic patients but not in diabetic patients.
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Choi et al. (2017) conducted a cohort in Coronary chronic total occlusion (n=1,547). Percutaneous coronary intervention vs. Medical therapy was evaluated on Cardiac death (HR 2.54, 95% CI 1.19-5.42, p=0.02). PCI for chronic total occlusion reduced cardiac death risk compared to medical therapy in non-diabetic patients (MT vs PCI HR 2.54; 95% CI 1.19-5.42; p=0.02), but not in diabetic patients.
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