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Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

BACKGROUND: Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS...

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Autores principales: Tsai, Chuan-Tsai, Huang, Wei-Chieh, Teng, Hsin-I, Tsai, Yi-Lin, Lu, Tse-Min
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395357/
https://www.ncbi.nlm.nih.gov/pubmed/32738906
http://dx.doi.org/10.1186/s12933-020-01093-6
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author Tsai, Chuan-Tsai
Huang, Wei-Chieh
Teng, Hsin-I
Tsai, Yi-Lin
Lu, Tse-Min
author_facet Tsai, Chuan-Tsai
Huang, Wei-Chieh
Teng, Hsin-I
Tsai, Yi-Lin
Lu, Tse-Min
author_sort Tsai, Chuan-Tsai
collection PubMed
description BACKGROUND: Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS AND RESULTS: From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1–10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349–0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156–0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095–0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn’t improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125–0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142–0.851, P: 0.021). CONCLUSIONS: Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population.
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spelling pubmed-73953572020-08-05 Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus Tsai, Chuan-Tsai Huang, Wei-Chieh Teng, Hsin-I Tsai, Yi-Lin Lu, Tse-Min Cardiovasc Diabetol Original Investigation BACKGROUND: Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS AND RESULTS: From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1–10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349–0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156–0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095–0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn’t improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125–0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142–0.851, P: 0.021). CONCLUSIONS: Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population. BioMed Central 2020-08-01 /pmc/articles/PMC7395357/ /pubmed/32738906 http://dx.doi.org/10.1186/s12933-020-01093-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Investigation
Tsai, Chuan-Tsai
Huang, Wei-Chieh
Teng, Hsin-I
Tsai, Yi-Lin
Lu, Tse-Min
Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title_full Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title_fullStr Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title_full_unstemmed Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title_short Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
title_sort long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395357/
https://www.ncbi.nlm.nih.gov/pubmed/32738906
http://dx.doi.org/10.1186/s12933-020-01093-6
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