title: Success rates of percutaneous coronary intervention of chronic total occlusions and long-term survival in patients with diabetes mellitus.
abstract: The objectives of this study were to evaluate angiographic and clinical outcomes among patients with diabetes mellitus (DM) who underwent percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO). We compared them with matched patients undergoing PCI of a non-CTO lesion. All patients had documented DM. Matching was performed using a propensity score for CTO. There were 506 patients with DM and CTO who were matched with a non-CTO group. Results showed that angiographic success rates were lower with CTO (75% vs. 93%, p<0.001). In-hospital major adverse cardiac event (MACE - death, urgent bypass surgery, Q-wave myocardial infarction or target vessel revascularisation) rates were equivalent (CTO 3.2% vs. non-CTO 2.6%, p=0.57). Survival was not different five years after revascularisation of CTO (75%) vs. non-CTO (79%) (p=0.20). In addition, when DM patients with CTO were analysed according to angiographic success of PCI, there were no significant differences in either in-hospital (success 1.6% vs. failure 2.4%, p=0.7) or 1-year mortality (success 22.2% vs. failure 26.8%, p=0.3). We conclude that PCI of CTO is safe in patients with DM. Angiographic failure is not associated with an increase in MACE rates or mortality as compared to matched non-CTO patients. However, there is not a measurable improvement in survival in this DM-CTO population.
authors.affiliation: Division of Cardiology and Biostatistics, Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Safley
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.forename: Barry D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome