Key result
CTO-PCI shows no significant MACE reduction over medical therapy in diabetic patients with CTO.
Why the study?
Whether percutaneous coronary intervention for chronic total occlusion in diabetic patients offers more benefits compared with initial medical therapy was unclear.
Does percutaneous coronary intervention improve outcomes compared to initial medical therapy in diabetic patients with stable chronic total occlusion?
Cohort (n=1,605)
Does percutaneous coronary intervention improve outcomes compared to initial medical therapy in diabetic patients with stable chronic total occlusion?
Hazard Ratio: 0.81 (95% CI 0.65–1.02)
In diabetic patients with stable chronic total occlusion, successful PCI offers significant survival benefits over initial medical therapy.
Whether percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers more benefits compared with initial medical therapy (CTO-MT) is unclear. In this study, diabetic patients with one CTO (clinical manifestations: stable angina or silent ischemia) were enrolled. Consecutively, enrolled patients ( n = 1605) were assigned to different groups: CTO-PCI (1044 [65.0%]) and initial CTO-MT (561 [35%]). After a median follow-up of 44 months, CTO-PCI tended to be superior to initial CTO-MT in major adverse cardiovascular events (adjusted hazard-ratio [aHR]: .81, 95% conference-interval: .65–1.02) and significantly superior in cardiac death (aHR: .58 [.39–.87]) and all-cause death (aHR: .678[.473–.970]). Such superiority mainly attributed to a successful CTO-PCI. CTO-PCI tended to be performed in patients with younger age, good collaterals, left anterior descending branch CTO, and right coronary artery CTO. While, those with left circumflex CTO and severe clinical/angiographic situations were more likely to be assigned to initial CTO-MT. However, none of these variables influenced the benefits of CTO-PCI. Thus, we concluded that for diabetic patients with stable CTO, CTO-PCI (mainly successful CTO-PCI) offered patients survival benefits over initial CTO-MT. These benefits were consistent regardless of clinical/angiographic characteristics.
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Yan et al. (2023) conducted a cohort in Diabetic patients with stable chronic total occlusion (n=1,605). Percutaneous coronary intervention (CTO-PCI) vs. Initial medical therapy (CTO-MT) was evaluated on Major adverse cardiovascular events (aHR 0.81, 95% CI 0.65-1.02). In diabetic patients with stable chronic total occlusion, CTO-PCI did not significantly reduce major adverse cardiovascular events compared to medical therapy (aHR 0.81; 95% CI 0.65-1.02).
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