Wang Qiang, Liu Hao, Ding Jiawang
Institute of Cardiovascular Diseases, Yichang Central People's Hospital, Yichang, Hubei Province Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China.
Medicine (Baltimore). 2017 Nov;96(45):e8499. doi: 10.1097/MD.0000000000008499.
Nowadays, due to advanced techniques and well-trained interventionists in catheter labs, new scientific research has shown percutaneous coronary intervention (PCI) to be a safe treatment procedure in patients with chronic total occlusion (CTO). However, no study has systematically compared PCI outcomes in CTO patients with versus without type 2 diabetes mellitus (T2DM). Therefore, through this meta-analysis we aimed to systematically solve this issue.
Between September 2016 and June 2017, the Cochrane Database of Randomized Trials, EMBASE, and MEDLINE databases were carefully searched for publications comparing PCI outcomes in CTO patients with versus without T2DM. Long-term (≥1 year) adverse clinical outcomes were considered the endpoints. Discontinuous data were analyzed by RevMan 5.3 whereby odds ratios (OR) and 95% confidence intervals (CIs) were the statistical parameters.
This analysis consisted of 1 randomized trial and 6 observational studies with a total number of 4571 patients with CTO (1915 patients with T2DM and 2656 patients without T2DM). Patients' enrollment was between the years 1998 and 2015.During this long-term follow-up (≥1 year), mortality was significantly higher in CTO patients with T2DM (OR: 1.56, 95% CI: 1.05-2.31; P = .03, I = 0%). Major adverse cardiac events (MACEs) and repeated revascularization were also significantly higher in patients with T2DM (OR: 1.30, 95% CI: 1.06-1.58; P = .01, I = 10%) and (OR: 1.30, 95% CI: 1.06-1.59; P = .01, I = 36%) respectively. However, myocardial infarction was not significantly different (OR: 1.01, 95% CI: 0.61-1.67; P = .96, I = 26%).
During this longer follow-up period post-PCI, mortality, MACEs and repeated revascularization in CTO patients with T2DM were significantly higher compared with similar patients without T2DM. Nevertheless, whether this hypothesis is relevant or not should be confirmed in larger trials.
如今，由于导管室技术的进步以及介入医生训练有素，新的科学研究表明经皮冠状动脉介入治疗（PCI）对于慢性完全闭塞（CTO）患者是一种安全的治疗方法。然而，尚无研究系统比较有和没有2型糖尿病（T2DM）的CTO患者的PCI治疗结果。因此，通过这项荟萃分析，我们旨在系统地解决这个问题。
在2016年9月至2017年6月期间，仔细检索了Cochrane随机试验数据库、EMBASE和MEDLINE数据库，以查找比较有和没有T2DM的CTO患者PCI治疗结果的出版物。长期（≥1年）不良临床结局被视为终点。采用RevMan 5.3对间断性数据进行分析，以比值比（OR）和95%置信区间（CI）作为统计参数。
该分析包括1项随机试验和6项观察性研究，共有4571例CTO患者（1915例T2DM患者和2656例非T2DM患者）。患者纳入时间为1998年至2015年。在这一长期随访（≥1年）期间，T2DM的CTO患者死亡率显著更高（OR：1.56，95%CI：1.05 - 2.31；P = 0.03，I = 0%）。T2DM患者的主要不良心脏事件（MACE）和再次血运重建也显著更高（分别为OR：1.30，95%CI：1.06 - 1.58；P = 0.01，I = 10%）和（OR：1.30，95%CI：1.06 - 1.59；P = 0.01，I = 36%）。然而，心肌梗死无显著差异（OR：1.01，95%CI：0.６1 - 1.67；P = 0.96，I = 26%）。
在PCI术后的这一较长随访期内，与无T2DM的类似患者相比，有T2DM的CTO患者的死亡率、MACE和再次血运重建显著更高。然而，这一假设是否成立应在更大规模的试验中得到证实。
