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Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes.
Flores-Umanzor, Eduardo J; Cepas-Guillen, Pedro L; Vázquez, Sara; Fernandez-Valledor, Andrea; Ivey-Miranda, Juan; Izquierdo, Marc; Caldentey, Guillem; Jimenez-Britez, Gustavo; Regueiro, Ander; Freixa, Xavier; Farrero, Marta; Ferreira-González, Ignacio; Martin-Yuste, Victoria; Sabaté, Manel.
Afiliación
  • Flores-Umanzor EJ; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Cepas-Guillen PL; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Vázquez S; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Fernandez-Valledor A; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Ivey-Miranda J; Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico.
  • Izquierdo M; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Caldentey G; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Jimenez-Britez G; Cardiology Department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain.
  • Regueiro A; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Freixa X; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Farrero M; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Ferreira-González I; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
  • Martin-Yuste V; Cardiology Department, Vall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
  • Sabaté M; Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Catheter Cardiovasc Interv ; 97(3): 376-383, 2021 02 15.
Article en En | MEDLINE | ID: mdl-32096926
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Oclusión Coronaria / Intervención Coronaria Percutánea Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Catheter Cardiovasc Interv Asunto de la revista: CARDIOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Oclusión Coronaria / Intervención Coronaria Percutánea Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Catheter Cardiovasc Interv Asunto de la revista: CARDIOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos