Key result
Diabetes fails to independently predict major cardiovascular events after successful CTO-PCI in patients with LVSD.
Why the study?
DM and LV systolic dysfunction are common in patients receiving PCI for CTO, but clinical outcomes over two years in this population with or without DM required investigation.
Does diabetes mellitus increase major adverse cardiovascular events in patients with LV systolic dysfunction undergoing successful percutaneous coronary intervention for chronic total occlusion?
Cohort (n=185)
No
Does diabetes mellitus increase major adverse cardiovascular events in patients with LV systolic dysfunction undergoing successful percutaneous coronary intervention for chronic total occlusion?
In patients with LV systolic dysfunction undergoing successful CTO-PCI, those with diabetes have higher crude rates of MACEs, but diabetes is not an independent predictor of MACEs when adjusting for factors like multi-vessel disease and chronic kidney disease.
Answers are grounded in this paper and cite their sources.
DM may worsen 2-year outcomes after successful CTO PCI in LV systolic dysfunction; leaves open whether glycemic optimization modifies prognosis.
Background: Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are common in patients who receive percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study aimed to investigate the clinical outcomes of LV systolic dysfunction patients who had successful PCI for CTO over two years, with or without DM. Methods: This cohort included 185 patients with LV systolic dysfunction undergoing successful PCI for CTO. A comparative analysis was performed on individual data and clinical outcomes among patients with and without DM after a two-year follow-up. Results: DM was identified in 99 (53.5%) patients who exhibited a higher incidence of chronic kidney disease (CKD), elevated serum creatinine levels, increased hemoglobin A1c, and reduced estimated glomerular filtration rates (p < 0.05). Patients with diabetes also experienced increased multi-vessel disease, a higher number of lesions per patient, as well as elevated multicenter chronic total occlusion registry in Japan (J-CTO) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (p < 0.05). During the two-year follow-up, the DM group showed a greater occurrence of major adverse cardiovascular events (MACEs) compared with the non-DM group (24.2% versus 12.8%, p < 0.001). The DM group also had higher rates of all-cause mortality (9.1% versus 3.5%, p < 0.002), cardiac death (8.1% versus 1.2%, p < 0.001), and target vessel revascularization (18.2% versus 7.1%, p < 0.001). Multivariable logistic regression analysis demonstrated that the presence of DM is not an independent predictor of MACEs (hazard ratio (HR): 0.58; 95% confidence interval (CI): 0.32 to 1.03; p = 0.260). Moreover, the multi-vessel disease (HR: 1.69; 95% CI: 1.21 to 2.36; p = 0.002), CKD (HR: 1.38; 95% CI: 1.08 to 1.78; p = 0.011) and complete revascularization (HR: 0.36; 95% CI: 0.14 to 0.88; p = 0.026) had a significant association with MACEs. Conclusions: In patients with LV systolic dysfunction who underwent successful CTO-PCI, those with diabetes exhibited a higher trend toward the incidence of MACEs over two years.
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Wu et al. (2024) conducted a cohort in Chronic Total Occlusion with Left Ventricular Systolic Dysfunction (n=185). Diabetes Mellitus vs. Without Diabetes Mellitus was evaluated on Major adverse cardiovascular events (MACEs) (HR 0.58, 95% CI 0.32-1.03, p=0.260). In patients with left ventricular systolic dysfunction undergoing successful CTO-PCI, diabetes mellitus was associated with a higher unadjusted 2-year major cardiovascular events rate but was not an independent predictor of MACEs.
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