| Objective:1.To study influencing factors concerning the theropies for the diabetic patients with chronic total occlusion(CTO) and the effect of theropies by comparing the long-term cardiovascular events.2.To investigate the factors influencing the coronary collateral channel development in diabetic patients with CTO.Methods:A total of265diabetic patients with CTO were selected who underwent angiography from Jan2007to Jan2012were enrolled into the present analysis. We recorded all the patients clinical and coronary angiography features.According to the theropies choosed after angiography,they were divided into two groups:percutaneous coronary intervention(PCI) group and medical treatment alone group. Various clinical features and long-term major advert cardiovascular events(MACE) at24mounths were compared between the two groups. The MACE included cardiac death(CD), re-myocardial infarction(re-MI), target vessel revascularization(TVR), coronary artery bypass surgery(CABG). Then all patients were categorized into two groups according to the condition of coronary collateral circulation.Results:(1)Total of247cases completed the follow-up, including males159cases and88cases females.24-mounths clinical outcomes showed that PCI group had significantly lower rates of all CD(5.0%vs12.6%)、CABG(5.6%vs17.2%)、 re-angina admitted to hospital(8.1%vs17.2%) and higher rate of TVR(11.3%vs2.3%) as compared with medical treatment alone group(P<0.05). The two groups had similar rates of MACE(21.9%vs32.2%) and re-MI(6.3%vs11.5%)(P>0.05). However, multivariable logistic analysis revealed that PCI (vs medical treatment alone) was not an independent risk factor for MACE (OR:0.140,95%CI:0.298～1.190, P=0.588) and CD(OR:1.086,95%CI:0.277～4.265, P=0.706).(2)The good coronary collateral channel group had significantly differences on males (69.8%vs55.8%), history of MI (24.0%vs14.0%) and smoking (34.1%vs 44.7%), Haemoglobin Alc (HbAlc)(6.84±0.85%vs7.11±0.98%), number of disease vessels (1.93±0.8vs1.74±0.8) and CTO of right coronary artery (53.6%vs40.7%) compared with the poor coronary collateral channel group(P<0.05). Multivariable logistic analysis revealed that history of smoking(OR:1.869,95%CI:1.084～3.221, P<0.05) and HbAlc(OR:1.371,95%CI:1.033～1.821, P<0.05) were independent predictors of the poor development of coronary collateral channel,but MI(OR:0.574,95%CI:0.341～0.954, P<0.05) was independent predictor of the good development of coronary collateral channel.Conclusion:1.The current data failed to show significant advantages of PCI theory for CTO with diabetic patients over medical treatment alone in24mounrhs, suggesting that we should considering the rate of benefits/risks to choose appropriate theropy in this subset of patients.2. History of smoking and high level of HbAlc were negative independent predictors of the development of coronary collateral circulation, but history of MI was protective independent predictor of the development of coronary collateral circulation. Considering and controlling there factors can take great advantages for diabetic patients with CTO. |
PDF Full Text Request