Chronic Total Occlusion PCI Improves Outcomes in Diabetes

PCI for chronic total occlusions tied to reduced long-term mortality, coronary bypass artery graft

TUESDAY, Sept. 20 (HealthDay News) -- Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is associated with reduced mortality and reduced need for coronary artery bypass grafting in patients with diabetes mellitus (DM), according to a study published in the Oct. 1 issue of The American Journal of Cardiology.

Bimmer E. Claessen, M.D., from the Cardiovascular Research Foundation in New York City, and colleagues investigated the long-term clinical outcomes after PCI of CTOs in 1,742 patients with known DM status (395 with and 1,347 without DM). Participants who underwent PCI of CTOs between 1998 and 2007 were evaluated for five-year clinical outcomes, stratified according to DM status; for successful versus failed CTO PCI; and for the use of drug-eluting (DES) versus bare-metal stents (BMS). Participants were followed up for an average of three years.

The investigators identified similar procedural success in patients with and without DM (P = 0.53). A total of 96.4 and 94 percent of patients with and without DM, respectively, had stent implantation after successful CTO PCI. Successful CTO PCI correlated with significantly reduced long-term mortality (10.4 versus 13.0 percent) and a significant reduction in the requirement for coronary artery bypass grafting (2.4 versus 15.7 percent) in patients with DM. The use of DES compared to BMS correlated with a decrease in target vessel revascularization in patients with (14.8 versus 54.1 percent) and without DM (17.6 versus 26.5 percent). In multivariate analysis, insulin-dependent DM was identified as an independent predictor of mortality in the DM cohort.

"Successful CTO PCI in patients with DM was associated with a reduction in mortality and the need for coronary artery bypass grafting," the authors write.

Two authors disclosed financial ties to Cordis Corporation. One of the study authors disclosed financial ties to Boston Scientific Corporation.

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