- Patients with diabetes who have chronic total occlusion (CTO) are just as likely as those without diabetes to benefit from percutaneous coronary intervention (PCI).
Why this matters
- CTOs are more common in patients with diabetes, yet they are less likely to be offered PCI.
- From the prospective, single-arm OPEN CTO registry, 1-y follow-up data analyzed from 1000 consecutive patients with CTO who underwent attempted PCI (82% underwent single-vessel) at 12 US sites, 2014-2015.
- Funding: Boston Scientific.
- 41% with diabetes had higher rates of prior bypass surgery and other cardiovascular and renal comorbidities.
- Crude technical success rates lower in patients with diabetes vs those without (83.5% vs 88.1%; P=.04).
- This association lost statistical significance after adjustment for potential clinical and angiographic confounders (relative risk, 0.96; P=.12).
- Prior bypass surgery was independently associated with lower technical success (P<.001).
- No significant differences observed in complication rates or adjusted health status scores between patients who did and did not have diabetes.
- Study limited to highly experienced PCI centers, so results may not be generalizable to all settings.
- Majority of patients not taking insulin.
- No comparison to treatment with guideline-directed medical therapy or bypass.
- Possible residual and unmeasured confounding.