Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Coronary chronic total occlusions (CTO) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). Despite this, the indication for percutaneous revascularization (PCI) and its clinical benefit in these patients remains controversial.

METHODS: A single center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients submitted to PCI between 2019-2020. Patients were divided in two groups regarding previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was the recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality.

RESULTS: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. Primary outcome (total symptoms recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs T2DM 21.2%, p=0.194) in a 2 year follow-up. Angina recurrence was significantly higher in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62 to 2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM with 1.5%, p=0.786 and 4.5%, p=0.352, respectively - survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85 to 0.99 and p=0.013, HR 0.96, 95% CI 0.93 to 0.99, respectively).

CONCLUSIONS: T2DM did not influence outcomes in CTO patients submitted to PCI, and its presence should not be a limiting factor in the decision of CTO revascularization.