Wu Xi, Li Qin, Wu Mingxing, Huang Haobo, Liu Zhe, Huang He, Wang Lei
Department of Cardiology, Xiangtan Central Hospital, 411100 Xiangtan, Hunan, China.
Rev Cardiovasc Med. 2024 Nov 7;25(11):396. doi: 10.31083/j.rcm2511396. eCollection 2024 Nov.
Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are common in patients who receive percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study aimed to investigate the clinical outcomes of LV systolic dysfunction patients who had successful PCI for CTO over two years, with or without DM.
This cohort included 185 patients with LV systolic dysfunction undergoing successful PCI for CTO. A comparative analysis was performed on individual data and clinical outcomes among patients with and without DM after a two-year follow-up.
DM was identified in 99 (53.5%) patients who exhibited a higher incidence of chronic kidney disease (CKD), elevated serum creatinine levels, increased hemoglobin A1c, and reduced estimated glomerular filtration rates ( < 0.05). Patients with diabetes also experienced increased multi-vessel disease, a higher number of lesions per patient, as well as elevated multicenter chronic total occlusion registry in Japan (J-CTO) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores ( < 0.05). During the two-year follow-up, the DM group showed a greater occurrence of major adverse cardiovascular events (MACEs) compared with the non-DM group (24.2% versus 12.8%, < 0.001). The DM group also had higher rates of all-cause mortality (9.1% versus 3.5%, < 0.002), cardiac death (8.1% versus 1.2%, < 0.001), and target vessel revascularization (18.2% versus 7.1%, < 0.001). Multivariable logistic regression analysis demonstrated that the presence of DM is not an independent predictor of MACEs (hazard ratio (HR): 0.58; 95% confidence interval (CI): 0.32 to 1.03; = 0.260). Moreover, the multi-vessel disease (HR: 1.69; 95% CI: 1.21 to 2.36; = 0.002), CKD (HR: 1.38; 95% CI: 1.08 to 1.78; = 0.011) and complete revascularization (HR: 0.36; 95% CI: 0.14 to 0.88; = 0.026) had a significant association with MACEs.
In patients with LV systolic dysfunction who underwent successful CTO-PCI, those with diabetes exhibited a higher trend toward the incidence of MACEs over two years.
糖尿病（DM）和左心室（LV）收缩功能障碍在接受经皮冠状动脉介入治疗（PCI）以处理慢性完全闭塞（CTO）的患者中很常见。本研究旨在调查成功进行CTO PCI超过两年的LV收缩功能障碍患者（无论有无DM）的临床结局。
该队列包括185例成功进行CTO PCI的LV收缩功能障碍患者。对随访两年后有DM和无DM患者的个体数据和临床结局进行了比较分析。
99例（53.5%）患者被诊断为DM，这些患者慢性肾脏病（CKD）发病率更高、血清肌酐水平升高、糖化血红蛋白升高以及估算肾小球滤过率降低（<0.05）。糖尿病患者还存在多支血管病变增加、每位患者病变数量增多，以及日本多中心慢性完全闭塞注册研究（J-CTO）和紫杉醇药物洗脱支架与心脏外科手术协同研究（SYNTAX）评分升高（<0.05）。在两年随访期间，DM组主要不良心血管事件（MACE）的发生率高于非DM组（24.2%对12.8%，<0.001）。DM组全因死亡率（9.1%对3.5%，<0.002）、心源性死亡（8.1%对1.2%，<0.001）以及靶血管血运重建率（18.2%对7.1%，<0.001）也更高。多变量逻辑回归分析表明，DM的存在不是MACE的独立预测因素（风险比（HR）：0.58；95%置信区间（CI）：0.32至1.03；P=0.260）。此外，多支血管病变（HR：1.69；95%CI：1.21至2.36；P=0.002）、CKD（HR：1.38；95%CI：1.08至1.78；P=0.011）和完全血运重建（HR：0.36；95%CI：0.14至0.88；P=0.026）与MACE显著相关。
在成功进行CTO-PCI的LV收缩功能障碍患者中，糖尿病患者在两年内发生MACE的趋势更高。
