Influence of Total Coronary Occlusion on Clinical Outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)

Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investig...

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Veröffentlicht in:The American journal of cardiology Jg. 117; H. 7; S. 1031 - 1038
Hauptverfasser: Damluji, Abdulla A., Pomenti, Sydney F., Ramireddy, Archana, Al-Damluji, Mohammed S., Alfonso, Carlos E., Schob, Alan H., Marso, Steven P., Gilchrist, Ian C., Moscucci, Mauro, Kandzari, David E., Cohen, Mauricio G.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.04.2016
Elsevier Limited
Schlagworte:
Aged
Cardiology
Cardiovascular
Cholesterol
Chronic Disease
Clinical outcomes
Coronary Artery Bypass
Coronary Occlusion - diagnosis
Coronary Occlusion - mortality
Coronary Occlusion - therapy
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - mortality
Diabetic Angiopathies - diagnosis
Diabetic Angiopathies - mortality
Diabetic Angiopathies - therapy
Female
Heart attacks
Humans
Male
Middle Aged
Mortality
Percutaneous Coronary Intervention
Survival Analysis
Treatment Outcome
ISSN:0002-9149, 1879-1913, 1879-1913
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Zusammenfassung:Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes, who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone according to the presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972 patients (41%) had CTO of coronary arteries. Of those, 482 (41%) and 490 (41%) were in the PR with IMT versus IMT only groups, respectively. In the PR group, patients with CTO were more likely to be selected for the coronary artery bypass grafting stratum (coronary artery bypass grafting 62% vs percutaneous coronary intervention 31%, p <0.001). Compared to the non-CTO group, patients with CTO had more abnormal Q wave, abnormal ST depression, and abnormal T waves. The myocardial jeopardy score was higher in the CTO versus non-CTO group (52 [36 to 69] vs 37 [21 to 53], p <0.001). After adjustment, 5-year mortality rate was significantly higher in the CTO group in the entire cohort (hazard ratio [HR] 1.35, p = 0.013) and in patients with CTO managed with IMT (HR 1.46, p = 0.031). However, the adjusted risk of death was not increased in patients managed with PR (HR 1.26, p = 0.180). In conclusion, CTO of coronary arteries is associated with increased mortality in patients treated medically. However, the presence of a CTO may not increase mortality in patients treated with revascularization. Larger randomized trials are needed to evaluate the effects of revascularization on long-term survival in patients with CTO.
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ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2015.12.047