title: Influence of Total Coronary Occlusion on Clinical Outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial).
abstract: Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes, who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone according to the presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972 patients (41%) had CTO of coronary arteries. Of those, 482 (41%) and 490 (41%) were in the PR with IMT versus IMT only groups, respectively. In the PR group, patients with CTO were more likely to be selected for the coronary artery bypass grafting stratum (coronary artery bypass grafting 62% vs percutaneous coronary intervention 31%, p <0.001). Compared to the non-CTO group, patients with CTO had more abnormal Q wave, abnormal ST depression, and abnormal T waves. The myocardial jeopardy score was higher in the CTO versus non-CTO group (52 [36 to 69] vs 37 [21 to 53], p <0.001). After adjustment, 5-year mortality rate was significantly higher in the CTO group in the entire cohort (hazard ratio [HR] 1.35, p = 0.013) and in patients with CTO managed with IMT (HR 1.46, p = 0.031). However, the adjusted risk of death was not increased in patients managed with PR (HR 1.26, p = 0.180). In conclusion, CTO of coronary arteries is associated with increased mortality in patients treated medically. However, the presence of a CTO may not increase mortality in patients treated with revascularization. Larger randomized trials are needed to evaluate the effects of revascularization on long-term survival in patients with CTO.
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida.
authors: Abdulla A
authors: AA
authors: Damluji
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida.
authors: Sydney F
authors: SF
authors: Pomenti
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida.
authors: Archana
authors: A
authors: Ramireddy
authors: Department of Internal Medicine, University of Connecticut, Farmington, Connecticut.
authors: Mohammed S
authors: MS
authors: Al-Damluji
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida.
authors: Carlos E
authors: CE
authors: Alfonso
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida.
authors: Alan H
authors: AH
authors: Schob
authors: Division of Cardiology, University of Texas Southwestern, Dallas, Texas.
authors: Steven P
authors: SP
authors: Marso
authors: Department of Medicine, Penn State Heart and Vascular Institute, Hershey, Pennsylvania.
authors: Ian C
authors: IC
authors: Gilchrist
authors: Department of Medicine, Cardiovascular Institute, Sinai Hospital, Baltimore, Maryland Sinai Hospital, Baltimore, Maryland.
authors: Mauro
authors: M
authors: Moscucci
authors: Division of Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
authors: David E
authors: DE
authors: Kandzari
authors: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: mgcohen@med.miami.edu.
authors: Mauricio G
authors: MG
authors: Cohen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D016019:Survival Analysis; D016896:Treatment Outcome