Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China.
Cardiovasc Diabetol. 2020 Jul 4;19(1):100. doi: 10.1186/s12933-020-01087-4.
In this study, we compared the outcomes of medical therapy (MT) with successful percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) patients with and without type 2 diabetes mellitus.
A total of 2015 patients with CTOs were stratified. Diabetic patients (n = 755, 37.5%) and non-diabetic patients (n = 1260, 62.5%) were subjected to medical therapy or successful CTO-PCI. We performed a propensity score matching (PSM) to balance the baseline characteristics. A comparison of the major adverse cardiac events (MACE) was done to evaluate long-term outcomes.
The median follow-up duration was 2.6 years. Through multivariate analysis, the incidence of MACE was significantly higher among diabetic patients compared to the non-diabetic patients (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.09-1.61, p = 0.005). Among the diabetic group, the rate of MACE (adjusted HR 0.61, 95% CI 0.42-0.87, p = 0.006) was significantly lower in the successful CTO-PCI group than in the MT group. Besides, in the non-diabetic group, the prevalence of MACE (adjusted HR 0.85, 95% CI 0.64-1.15, p = 0.294) and cardiac death (adjusted HR 0.94, 95% CI 0.51-1.70, p = 0.825) were comparable between the two groups. Similar results as with the early detection were obtained in propensity-matched diabetic and non-diabetic patients. Notably, there was a significant interaction between diabetic or non-diabetic with the therapeutic strategy on MACE (p for interaction = 0.036).
For treatment of CTO, successful CTO-PCI highly reduces the risk of MACE in diabetic patients when compared with medical therapy. However, this does not apply to non-diabetic patients.
在这项研究中，我们比较了成功经皮冠状动脉介入治疗（PCI）与药物治疗（MT）在伴有和不伴有 2 型糖尿病的慢性完全闭塞（CTO）患者中的结局。
将 2015 例 CTO 患者分层。糖尿病患者（n=755，37.5%）和非糖尿病患者（n=1260，62.5%）分别接受药物治疗或成功的 CTO-PCI。我们进行了倾向评分匹配（PSM）以平衡基线特征。比较主要不良心脏事件（MACE）以评估长期结局。
中位随访时间为 2.6 年。通过多变量分析，与非糖尿病患者相比，糖尿病患者的 MACE 发生率明显更高（调整后的危险比 [HR] 1.32，95%置信区间 [CI] 1.09-1.61，p=0.005）。在糖尿病组中，与 MT 组相比，成功 CTO-PCI 组的 MACE 发生率（调整后的 HR 0.61，95%CI 0.42-0.87，p=0.006）显著降低。此外，在非糖尿病组中，两组之间 MACE（调整后的 HR 0.85，95%CI 0.64-1.15，p=0.294）和心脏死亡（调整后的 HR 0.94，95%CI 0.51-1.70，p=0.825）的发生率无差异。在倾向匹配的糖尿病和非糖尿病患者中也获得了与早期检测相似的结果。值得注意的是，糖尿病或非糖尿病与治疗策略对 MACE 的交互作用有显著差异（p 交互=0.036）。
对于 CTO 的治疗，与药物治疗相比，成功的 CTO-PCI 可显著降低糖尿病患者 MACE 的风险。然而，这不适用于非糖尿病患者。
