Chronic total coronary occlusion treated by percutaneous coronary intervention: Long-term outcome in patients with and without diabetes

Aims: Despite technical advancements, long-term outcomes after chronic total occlusion (CTO) recanalisation remain a subject of debate, especially in diabetic patients. The aim of this study, therefore, was to assess the very long-term clinical outcome of diabetic vs. non-diabetic patients in a large cohort from a high-volume CTO PCI centre according to whether or not CTO recanalisation had been successfully achieved. Methods and results: Between 2004 and 2012, 1,320 consecutive patients underwent PCI for CTO, 27.4% (362/1320) of whom were diabetics. We compared cardiac death, target lesion revascularisation (TLR), myocardial infarction (MI) and combined major adverse cardiac events (MACE) in patients with successful versus failed PCI (median follow-up 4.2 years). The PCI success rate was 75% (990/1,320 patients), with no significant differences between diabetics and non-diabetics (69.8% vs. 75%, respectively, p=0.07). Successful recanalisation was associated with lower cardiac death rates (13.2% vs. 17.2%, respectively, p<0.001) and lower MACE (27.5% vs. 33.7%, respectively, p=0.02). There were no significant differences in TLR (8.9% vs. 14.2% for failed recanalisation, p=0.29) and MI (4.7% vs. 10% for failed recanalisation). Successful recanalisation was a predictor of survival (HR 0.5, 95% CI: 0.32-0.81, p=0.005), whereas diabetes (HR 2.44, 95% CI: 1.52-3.83, p<0,001), left ventricular ejection fraction (HR 0.96, 95% CI: 0.94-0.99, p=0.004) and age (HR 1.06, 95% CI: 1.03-1.08, per year increment, p<0.0001) were predictors of cardiac death at follow-up. Cardiac mortality rates varied markedly after failed PCI between diabetic (20/103, 24.7%) and non-diabetic patients (15/227, 9.3%, p<0.0001 for comparison between groups), suggesting an interaction between the presence of diabetes and procedural outcome. Conclusions: CTO recanalisation was associated with improved long-term survival, a reduced rate of MACE for up to nine years, and suggests a greater reduction in cardiac death among diabetic patients.