title: Long-term clinical outcomes of percutaneous coronary intervention for chronic total occlusions in patients with versus without diabetes mellitus.
abstract: There is a paucity of data on long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in the high-risk group of patients with diabetes mellitus (DM). The aim of this study was to evaluate long-term clinical outcomes after PCI of CTOs in patients with and without DM. A total of 1,742 patients with known DM status underwent PCI of CTOs at 3 tertiary care centers in the United States, South Korea, and Italy from 1998 to 2007. Five-year clinical outcomes were evaluated in patients with successful versus failed CTO PCI and the use of drug-eluting stents (DES) versus bare-metal stents (BMS) stratified according to DM status. A total of 395 patients (23%) had DM (42% of whom had insulin-dependent DM). Procedural success was similar in patients with versus without DM (69.6% vs 67.9%, p = 0.53). After successful CTO PCI, stents were implanted in 96.4% of patients with DM (BMS in 23.8%, DES in 76.2%) and in 94.0% of patients without DM (BMS in 38.6%, DES in 61.4%). Median follow-up was 3.0 years. In patients with DM, successful CTO PCI was associated with reduced long-term mortality (10.4% vs 13.0%, p <0.05) and a reduced need for coronary artery bypass grafting (2.4% vs 15.7%, p <0.01). The use of DES was associated with a reduction in target vessel revascularization in patients with DM (14.8% vs 54.1%, p <0.01) and in those without DM (17.6% vs 26.5%, p <0.01). Multivariate analysis identified insulin-dependent DM as an independent predictor of mortality in the DM cohort. In conclusion, successful CTO PCI in patients with DM was associated with a reduction in mortality and the need for coronary artery bypass grafting. Compared to non-insulin-dependent DM, patients with insulin-dependent DM had an increased risk for long-term mortality. The use of DES rather than BMS was associated with a reduction in target vessel revascularization in patients with and without DM.
authors.affiliation: Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Kotaro
authors.initials: K
authors.lastname: Obunai
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome