Key result
Diabetes linked to ~6.7-fold higher MACE risk in elderly patients undergoing CTO PCI.
Why the study?
The prognosis of elderly patients with chronic total occlusion and diabetes mellitus treated with PCI was not known.
Does diabetes mellitus increase the risk of MACE in elderly patients with chronic total occlusion successfully treated with PCI?
Cohort (n=153)
Does diabetes mellitus increase the risk of MACE in elderly patients with chronic total occlusion successfully treated with PCI?
Hazard Ratio: 6.69 (95% CI 1.62–15.81)
Absolute Event Rate: 29.4% vs 11.3%
p-value: p=0.01
Diabetes mellitus is a strong independent predictor of long-term major adverse cardiac events in elderly patients undergoing successful PCI for chronic total occlusion.
May support closer post-PCI surveillance in diabetic elderly with CTO; leaves open whether targeted interventions improve outcomes.
BACKGROUND: The prognosis of elderly patients with chronic total occlusion (CTO) and diabetes mellitus (DM) treated with percutaneous coronary intervention (PCI) is not known. OBJECTIVE: To investigate the effect of diabetes on long-term follow-up of CTO after PCI in elderly patients. METHODS: A total of 153 elderly patients (age > 65 years old) with CTO lesions which were successfully treated with PCI were enrolled. Fifty one patients with diabetes and 102 without diabetes were compared for long-term outcomes (mean follow up: 36 ± 12 months). Major adverse cardiac events (MACE) which include death, myocardial infarction or target lesion revascularization (TLR) were considered as a combined endpoint. RESULTS: The combined endpoint occurred in 29.4% of diabetes patients, and 11.3% of the patients without diabetes (P < 0.05). The Cox proportional hazards model identified: drug eluting stent (DES) or bare metal stent (BMS) (HR: 0.13, 95% confidence interval (95% CI): 0.03-0.62, P = 0.004), DM (HR: 6.69, 95% CI: 1.62-15.81, P = 0.01) and final minimal lumen diameter (MLD) (HR: 0.37, 95% CI: 0.13-0.90, P = 0.03 ) as independent predictors of MACE, DM with renal impairment (HR: 6.64, 95% CI: 1.32-33.36, P = 0.02), HBA1C on admission (HR: 1.79, 95% CI: 1.09-2.94, P = 0.02), as independent predictors of MACE at long term follow-up. CONCLUSIONS: The study demonstrates that DM is a predictive factor for MACE in elderly CTO patients treated with PCI, type of stent, final minimal lumen diameter and DM with renal impairment, and HBA1C level on admission are predictors of MACE.
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Liu et al. (2013) conducted a cohort in Chronic total occlusion (CTO) (n=153). Diabetes mellitus vs. No diabetes was evaluated on Major adverse cardiac events (MACE) including death, myocardial infarction or target lesion revascularization (TLR) (HR 6.69, 95% CI 1.62-15.81, p=0.01). Diabetes mellitus was associated with a significantly higher risk of MACE in elderly patients with chronic total occlusion treated with PCI (29.4% vs 11.3%; HR 6.69, 95% CI 1.62-15.81; P=0.01).
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