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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Published in:	The American journal of cardiology Vol. 117; no. 7; pp. 1031 - 1038
Main Authors:	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
Language:	English
Published:	United States Elsevier Inc 01.04.2016 Elsevier Limited
Subjects:	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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Abstract	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.
AbstractList	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. 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. 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.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.
Author	Gilchrist, Ian C. Al-Damluji, Mohammed S. Marso, Steven P. Damluji, Abdulla A. Schob, Alan H. Moscucci, Mauro Kandzari, David E. Pomenti, Sydney F. Alfonso, Carlos E. Cohen, Mauricio G. Ramireddy, Archana
Author_xml	– sequence: 1 givenname: Abdulla A. orcidid: 0000-0002-8774-6416 surname: Damluji fullname: Damluji, Abdulla A. organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida – sequence: 2 givenname: Sydney F. surname: Pomenti fullname: Pomenti, Sydney F. organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida – sequence: 3 givenname: Archana orcidid: 0000-0003-4874-8715 surname: Ramireddy fullname: Ramireddy, Archana organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida – sequence: 4 givenname: Mohammed S. surname: Al-Damluji fullname: Al-Damluji, Mohammed S. organization: Department of Internal Medicine, University of Connecticut, Farmington, Connecticut – sequence: 5 givenname: Carlos E. surname: Alfonso fullname: Alfonso, Carlos E. organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida – sequence: 6 givenname: Alan H. surname: Schob fullname: Schob, Alan H. organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida – sequence: 7 givenname: Steven P. orcidid: 0000-0002-4312-536X surname: Marso fullname: Marso, Steven P. organization: Division of Cardiology, University of Texas Southwestern, Dallas, Texas – sequence: 8 givenname: Ian C. surname: Gilchrist fullname: Gilchrist, Ian C. organization: Department of Medicine, Penn State Heart and Vascular Institute, Hershey, Pennsylvania – sequence: 9 givenname: Mauro surname: Moscucci fullname: Moscucci, Mauro organization: Department of Medicine, Cardiovascular Institute, Sinai Hospital, Baltimore, Maryland Sinai Hospital, Baltimore, Maryland – sequence: 10 givenname: David E. surname: Kandzari fullname: Kandzari, David E. organization: Division of Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia – sequence: 11 givenname: Mauricio G. surname: Cohen fullname: Cohen, Mauricio G. email: mgcohen@med.miami.edu organization: Cardiovascular Division, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida
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Snippet	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...
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SubjectTerms	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
Title	Influence of Total Coronary Occlusion on Clinical Outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)
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