Diabetes doesn’t hinder PCI success in treating CTO

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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • 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.