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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Chronic total occlusion percutaneous treatment in patients with Diabetes. Same outcomes?
Session:
Posters 2 - Écran 4 - Intervenção / Cirurgia Cardíaca
Speaker:
Ana Vera Marinho
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Ana Vera Marinho; Joana M. Ribeiro; Luís Graça Santos; Patrícia M. Alves; Célia Domingues; Manuel Oliveira Santos; Luís Candal Leite; Luis Paiva; Hilário Oliveira; Elisabete Jorge; Joana Delgado Silva; Vitor Azevedo Matos; Francisco Gonçalves; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background:</strong> Diabetes is common among patients who present with coronary chronic total occlusions (CTOs), and is often associated with diffuse and more severe disease. Although CTOs are more common in diabetic patients, percutaneous coronary intervention (PCI) is performed less frequently in these patients. Prior studies have showed conflicting results regarding technical success, periprocedural complications and long-term major adverse cardiac event rates among those with diabetes. We aim to evaluate the association between diabetes and technical success, peri procedural complications and long-term outcomes.</p> <p><strong>Methods: </strong>We conducted a prospective, cohort study including all consecutive patients enrolled in our CTO program from December, 2013 to November, 2018. Angiographic data included the number of diseased vessels, the SYNTAX score and the Japanese CTO (J-CTO) score. Two groups were considered: patients with previous diagnostic of type 1/2 diabetes (group 1) and the group without diabetes (group 2). We defined a co-primary safety outcome (procedure-related complications) and a co-primary efficacy outcome (procedural success). A follow-up with a mean duration of 470 ± 420 days was conducted. Secondary endpoints included death, myocardial infarction (MI) and target lesion revascularization (TVR); CCS class assessment and impact on left ventricular ejection fraction (LVEF) on follow-up.</p> <p><strong>Results: </strong>A total of 195 patients (mean age 66±10 years, 81% male) with 202 CTO lesions were included. Diabetic patients were older 68 ± 8 vs 65 ±10 years, p=0.002) and more frequently had hypertension (58% vs 42%, p=0.01), excessive weight (mean BMI 28±3 vs 26±2, p=0.04) and chronic renal disease (56 vs 44%) p=0.04. Group 1 pts had higher J score values (2.8vs1.9, p=0.04). The procedural success was similar between groups (90.3 vs 94.3%, p=0.39) and both groups did not differ in rate of procedural complications (4.2% vs 3.3%, p=0.90). In follow up period 5pts died in group 1 and 2 pts in group 2 (5.3vs3.5%, p=0.71).The groups did not differ in admission for MI or rate of TVRs (6.5%vs4.5%, p=0.60). CCS class decreased following a successful CTO treatment in both groups (90.3%vs92.3%, p=0.01). Regarding LVEF variation after a successful CTO intervention, we found a significant increase in both groups (86.0 vs77% vs 52%, p=0.61). </p> <p><strong>Conclusions: </strong>In this study, although diabetic patients had more comorbilities and more severe disease, these patients had received similar benefits without increase in rate of complications.</p>
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