Long-term Prognosis Of Patients With Coronary Chronic Total Occlusion With Diabetes Undergoing Percutaneous Coronary Intervention

Research Background And Objective: Among patients undergoing coronary angiography,more than 30% are suggestive of coronary chronic total occlusion(CTO)disease.CTO percutaneous coronary intervention(PCI)has complicated operation,high radiation dose,large amount of contrast agent,and high incidence of surgical complications.CTO remains challenging for interventional treatment of coronary heart disease.About 34%-40% of CTO patients have diabetes.With the increase of the duration of diabetes,the incidence of coronary heart disease increases.Patients with coronary heart disease and diabetes usually have diffuse and complicated coronary lesions,more common calcified lesions,as well as endothelial cell dysfunction,microcirculation disorders and worse clinical prognosis.The aim of the present study was to assess the long-term prognosis of patients with CTO and diabetes following successful PCI vs.medical therapy(MT).Methods: The cohort of this retrospective observational study consisted of patients with at least one angiographically confirmed CTO lesion who underwent successful PCI or MT at The First Affiliated Hospital of Dalian Medical University from January 1,2016 to December 31,2018.The patient’s clinical baseline data,treatment strategy,and coronary artery disease were recorded.Patients were assigned to the diabetes group or the non-diabetes group.Based on the treatment strategy,the patients were further assigned to the successful PCI group or the MT group.The clinical follow-up of the enrolled patients was completed on December 31,2019.The primary endpoint was cardiogenic death,while the secondary endpoint was a major adverse cardiovascularevents(MACEs),which included cardiac death,acute myocardial infarction,heart failure,stent restenosis,readmission and revascularization of target lesions.Results: A total of 1291 CTO patients were included in this study,557 patients were excluded,and 734 patients were finally enrolled.The median follow-up duration was 20 months.The results showed that the prevalence of diabetes in CTO patients was40.2%.As compared to patients in the non-diabetes group,those in the diabetes group were older(65.6 ± 9.6 vs.63.9 ± 11.1 years,respectively,p = 0.031),with a longer total length of the stent implanted during PCI(50.5 ± 24 vs 47.7 ± 22.2 mm,p < 0.001)and higher frequencies of hypertension(76.6% vs.63.3%,p <0.001),previous PCI(39.7%vs.28.7%,p = 0.002),heart failure(21.0% vs.10.7%,p < 0.001),chronic kidney disease(14.6% vs.9.6%,p = 0.038),and multivessel disease(80.0% vs.74.0%,p =0.011).The diabetes group also had a lower percentage of males(71.9% vs.81.3%,p =0.003),incidence of left ventricular ejection fraction(52 ± 9.4 vs.54.3 ± 8.1,p <0.001),and mean HDL-C levels(1.03 ± 0.25 vs.1.08 ± 0.25,p = 0.002).There was a significant difference in the incidence of MACEs between the diabetic and non-diabetes groups(48.1% vs.39.9%,p = 0.027),but not in the incidence of cardiac death(5.1% vs2.7%,p = 0.097).Among patients with diabetes,there was a significant difference in the incidence of cardiac death between the MT and successful PCI groups(6.9% vs.1.1%,p = 0.043),but not in the incidence of MACEs(46.6% vs.51.6%,p = 0.420).In the non-diabetes group,there was no significant difference in the incidence of cardiac death(2.9% vs.2.4%,p = 0.995)or MACEs(42.7% vs.35.2%,p = 0.118)between the MT and successful PCI groups.A Kaplan-Meier survival curve to analyze the survival of CTO patients.There was statistically significant difference in the survival of diabetes patients undergoing successful PCI vs.MT(94.4% vs 88.7%,p = 0.035),but not in the non-diabetes patients(97.2% vs 96.7%,p = 0.734).Multivariate regression analysis revealed that diabetes(HR=1.270,CI=1.001-1.612,P=0.049)was identified as independent risk factor for MACEs in CTO patients.Conclusion: As compared with the non-diabetes group,there was a higher incidence of MACEs among CTO patients in the diabetes group,but no significantdifference in cardiac mortality.For CTO patients with diabetes,successful PCI could reduce the risk of cardiac death,but not the incidence of MACEs as compared with MT.Diabetes was identified as independent risk factor for MACEs of CTO patients.