Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Left Ventricular Systolic Dysfunction Patients with and without Diabetes Mellitus.

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI:10.31083/j.rcm2511396
Xi Wu, Qin Li, Mingxing Wu, Haobo Huang, Zhe Liu, He Huang, Lei Wang
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Abstract

Background: Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are common in patients who receive percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study aimed to investigate the clinical outcomes of LV systolic dysfunction patients who had successful PCI for CTO over two years, with or without DM.

Methods: This cohort included 185 patients with LV systolic dysfunction undergoing successful PCI for CTO. A comparative analysis was performed on individual data and clinical outcomes among patients with and without DM after a two-year follow-up.

Results: DM was identified in 99 (53.5%) patients who exhibited a higher incidence of chronic kidney disease (CKD), elevated serum creatinine levels, increased hemoglobin A1c, and reduced estimated glomerular filtration rates (p < 0.05). Patients with diabetes also experienced increased multi-vessel disease, a higher number of lesions per patient, as well as elevated multicenter chronic total occlusion registry in Japan (J-CTO) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (p < 0.05). During the two-year follow-up, the DM group showed a greater occurrence of major adverse cardiovascular events (MACEs) compared with the non-DM group (24.2% versus 12.8%, p < 0.001). The DM group also had higher rates of all-cause mortality (9.1% versus 3.5%, p < 0.002), cardiac death (8.1% versus 1.2%, p < 0.001), and target vessel revascularization (18.2% versus 7.1%, p < 0.001). Multivariable logistic regression analysis demonstrated that the presence of DM is not an independent predictor of MACEs (hazard ratio (HR): 0.58; 95% confidence interval (CI): 0.32 to 1.03; p = 0.260). Moreover, the multi-vessel disease (HR: 1.69; 95% CI: 1.21 to 2.36; p = 0.002), CKD (HR: 1.38; 95% CI: 1.08 to 1.78; p = 0.011) and complete revascularization (HR: 0.36; 95% CI: 0.14 to 0.88; p = 0.026) had a significant association with MACEs.

Conclusions: In patients with LV systolic dysfunction who underwent successful CTO-PCI, those with diabetes exhibited a higher trend toward the incidence of MACEs over two years.

经皮冠状动脉介入治疗合并或不合并糖尿病的左室收缩功能不全慢性闭塞患者的成功。
背景:糖尿病(DM)和左心室(LV)收缩功能障碍在接受经皮冠状动脉介入治疗(PCI)的慢性全闭塞(CTO)患者中很常见。本研究旨在探讨伴有或不伴有糖尿病的左室收缩功能障碍患者在两年内成功行CTO PCI治疗的临床结果。方法:该队列包括185例成功行CTO PCI治疗的左室收缩功能障碍患者。在两年的随访后,对糖尿病患者和非糖尿病患者的个人数据和临床结果进行了比较分析。结果:99例(53.5%)慢性肾脏疾病(CKD)发生率较高、血清肌酐水平升高、血红蛋白A1c升高、肾小球滤过率降低的患者中存在糖尿病(p < 0.05)。糖尿病患者还经历了多血管疾病的增加,每位患者的病变数量更高,日本多中心慢性全闭塞登记(J-CTO)和经皮冠状动脉介入治疗与心脏手术(SYNTAX)评分的提高(p < 0.05)。在两年的随访中,糖尿病组的主要不良心血管事件(mace)发生率高于非糖尿病组(24.2% vs 12.8%, p < 0.001)。糖尿病组的全因死亡率(9.1%比3.5%,p < 0.002)、心源性死亡(8.1%比1.2%,p < 0.001)和靶血管重建术(18.2%比7.1%,p < 0.001)也更高。多变量logistic回归分析显示DM的存在不是mace的独立预测因子(风险比(HR): 0.58;95%置信区间(CI): 0.32 ~ 1.03;P = 0.260)。多支血管病变(HR: 1.69;95% CI: 1.21 ~ 2.36;p = 0.002), CKD (HR: 1.38;95% CI: 1.08 ~ 1.78;p = 0.011)和完全血运重建术(HR: 0.36;95% CI: 0.14 ~ 0.88;p = 0.026)与mace显著相关。结论:在成功行CTO-PCI的左室收缩功能障碍患者中,糖尿病患者在两年内表现出更高的mace发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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