Division of Cardiology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
Curr Cardiol Rep. 2019 Feb 21;21(2):9. doi: 10.1007/s11886-019-1091-2.
Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM.
Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox). CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
糖尿病（DM）在接受慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的患者中发病率较高。本综述旨在总结 DM 患者 CTO 再通的现有证据。
对于合并多支血管病变的 DM 患者，冠状动脉旁路移植术（CABG）是推荐的血运重建方式。然而，对于合并 CTO 和单支血管病变或既往 CABG 的 DM 患者，最佳的管理策略仍然是一个临床难题。目前，大规模、观察性注册研究支持以下观点，即如果由经验丰富的术者在高容量 CTO PCI 中心进行 CTO PCI，那么在 DM 患者和非 DM 患者中，该操作具有相似的高成功率和低并发症发生率。尽管 DM 患者 CTO 更为常见，并且可能从完全血运重建中获益更多，但与非 DM 患者相比，他们接受 CTO PCI 的频率更低（治疗风险悖论）。对于不适合 CABG 的特定 DM CTO 患者，由经验丰富的术者进行 CTO PCI 是一种安全有效的治疗选择。需要随机研究来比较 CTO PCI 和药物治疗在这一高危亚组中的长期结果。
