Juan Ruiz-Garcia1, Rui Teles2, José-Ramón Rumoroso3, Henrique Cyrne Carvalho4, Francisco Javier Goicolea5, José Moreu6, Josefa Mauri7, Vicente Mainar8, Eulogio García9, Raul Moreno10. 1. Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quiron, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de Torrejón, Madrid, Spain. 2. Servicio de Cardiología, Hospital de Santa Cruz, Lisboa, Portugal. 3. Servicio de Cardiología, Hospital de Galdakao, Bilbao, Spain. 4. Servicio de Cardiología, Hospital de Santo Antonio, Porto, Portugal. 5. Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Spain. 6. Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain. 7. Servicio de Cardiología, Hospital German Trias i Pujol, Badalona, Spain. 8. Servicio de Cardiología, Hospital General, Alicante, Spain. 9. Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain. 10. Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. Electronic address: raulmorenog@hotmail.com.
Abstract
OBJECTIVE: Diabetes mellitus and chronic total occlusions are associated with unfavorable outcome after percutaneous coronary intervention. We sought to assess the clinical and angiographic outcomes of diabetic and non-diabetic patients who underwent successful percutaneous revascularization of chronic total occlusions with drug-eluting stents. METHODS: Baseline clinical and angiographic characteristics, procedural details, nine-month angiographic follow-up and clinical events at 12 months were compared between 75 diabetic and 132 non-diabetic patients included in a clinical trial that randomized successful recanalization of chronic total occlusions to receive sirolimus- or everolimus-eluting stents. RESULTS: In both diabetic and non-diabetic groups there was a favorable non-significantly different angiographic result at nine months, with low in-stent late loss (0.14±0.60 mm vs. 0.25±0.68 mm, p=0.305) and rates of binary restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%, p=0.334). During follow-up similar survival from death (97.3±1.9% vs. 99.2±0.8%, log-rank p=0.273), acute myocardial infarction (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192), target vessel revascularization (88.7±3.8% vs. 88.2±2.9%, log-rank p=0.899) and stent thrombosis (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192) was observed. Furthermore, the presence of more diffuse peripheral and coronary artery disease and higher frequency of calcified lesions in diabetic patients did not lead to significant differences in the approach (20.0% vs. 25.0% radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy, p=0.353), total stent length (48.1±24.6 mm vs. 49.2±23.9 mm, p=0758) or contrast volume (261.3±116.4 ml vs. 297.4±135.9 ml, p=0.109) required for revascularization. CONCLUSIONS: In the drug-eluting stent era, diabetic and non-diabetic patients have comparable favorable clinical and angiographic outcomes after successful percutaneous revascularization of chronic total occlusions.
RCT Entities:
OBJECTIVE:Diabetes mellitus and chronic total occlusions are associated with unfavorable outcome after percutaneous coronary intervention. We sought to assess the clinical and angiographic outcomes of diabetic and non-diabeticpatients who underwent successful percutaneous revascularization of chronic total occlusions with drug-eluting stents. METHODS: Baseline clinical and angiographic characteristics, procedural details, nine-month angiographic follow-up and clinical events at 12 months were compared between 75 diabetic and 132 non-diabeticpatients included in a clinical trial that randomized successful recanalization of chronic total occlusions to receive sirolimus- or everolimus-eluting stents. RESULTS: In both diabetic and non-diabetic groups there was a favorable non-significantly different angiographic result at nine months, with low in-stent late loss (0.14±0.60 mm vs. 0.25±0.68 mm, p=0.305) and rates of binary restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%, p=0.334). During follow-up similar survival from death (97.3±1.9% vs. 99.2±0.8%, log-rank p=0.273), acute myocardial infarction (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192), target vessel revascularization (88.7±3.8% vs. 88.2±2.9%, log-rank p=0.899) and stent thrombosis (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192) was observed. Furthermore, the presence of more diffuse peripheral and coronary artery disease and higher frequency of calcified lesions in diabeticpatients did not lead to significant differences in the approach (20.0% vs. 25.0% radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy, p=0.353), total stent length (48.1±24.6 mm vs. 49.2±23.9 mm, p=0758) or contrast volume (261.3±116.4 ml vs. 297.4±135.9 ml, p=0.109) required for revascularization. CONCLUSIONS: In the drug-eluting stent era, diabetic and non-diabeticpatients have comparable favorable clinical and angiographic outcomes after successful percutaneous revascularization of chronic total occlusions.
Authors: J R Martinez-Parachini; A Karatasakis; D Karmpaliotis; K Alaswad; F A Jaffer; R W Yeh; M Patel; J Bahadorani; A Doing; P-K Nguyen-Trong; B A Danek; J Karacsonyi; A Alame; B V Rangan; C A Thompson; S Banerjee; E S Brilakis Journal: Diabet Med Date: 2016-11-03 Impact factor: 4.359