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Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes
Author(s) -
FloresUmanzor Eduardo J.,
CepasGuillen Pedro L.,
Vázquez Sara,
FernandezValledor Andrea,
IveyMiranda Juan,
Izquierdo Marc,
Caldentey Guillem,
JimenezBritez Gustavo,
Regueiro Ander,
Freixa Xavier,
Farrero Marta,
FerreiraGonzález Ignacio,
MartinYuste Victoria,
Sabaté Manel
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28815
Subject(s) - medicine , conventional pci , revascularization , percutaneous coronary intervention , hazard ratio , cardiology , ejection fraction , diabetes mellitus , coronary artery disease , myocardial infarction , confidence interval , surgery , heart failure , endocrinology
Background Chronic total occlusion (CTO) is common in patients with diabetes mellitus. Data on the long‐term outcomes after treatment of CTOs in this high‐risk population are scarce. Aim To compare the long‐term clinical outcomes of CTO revascularization either by coronary artery bypass graft (CABG) or successful percutaneous coronary intervention (PCI) versus optimal medical treatment (MT) alone in patients with diabetes. Methods and Results A total of 538 consecutive patients with diabetes and at least one CTO were identified from 2010 to 2014 in our center. In the present analysis, patients were stratified according to the CTO treatment strategy that was selected. MT was selected in 61% of patients whereas revascularization in the remaining 39%. Patients undergoing revascularization were younger, had higher left ventricular ejection fraction (LVEF), lower ACEF score, and more positive myocardial ischemia detection results compared to the MT group ( p < .001).Patients referred for CABG had higher rates of left main disease compared to the PCI and MT groups (32% vs. 3% and 11%, respectively; p < .001). Complete revascularization was more often achieved in the CABG group, compared to the PCI group (62% vs. 32% p < .001). Multivariable analysis showed that revascularization with CABG was associated with lower rates of all‐cause and cardiac mortality rates compared to MT, [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25–0.70, p < .001 and HR 0.40, 95% CI 0.20–81, p = .011, respectively]. Successful CTO‐PCI showed a trend towards benefit in all‐cause mortality (HR 0.58, 95% CI 0.33–1.04, p = .06). Conclusion In our registry, CTO revascularization in diabetic patients, especially with CABG, was associated with lower long‐term mortality rates as compared to MT alone.