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Procedural and Long-Term Prognosis After Successful CTO Recanalization in Patients with Type 2 Diabetes: A Unicentric Study
Session:
Comunicações Orais - Sessão 06 - Doença coronária
Speaker:
Ana L. Silva
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana L. Silva; Gonçalo Terleira Batista; Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Ana Luísa Rocha; Tomás Carlos; Mafalda Griné; Bernardo Resende; José Luís Martins; Joana Silva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Type 2 diabetes (T2D) patients have a high prevalence of chronic total occlusions (CTOs). Despite coronary artery bypass grafting (CABG) being the recommended revascularization approach for T2D with multivessel disease, the ideal strategy for managing CTOs in diabetics with single-vessel disease or those unsuitable for surgery remains sparse.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Single-center, retrospective study. Patients undergoing CTO percutaneous coronary intervention (PCI) from 2017 to 2023 were included. We aimed to assess the procedural and long-term clinical outcomes following successful CTO-PCI in patients with and without T2D. Statistical analysis was performed using SPSS 28.0.1.1 software.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 118 patients were included (55 with T2D vs. 63 with no T2D). The mean age of the population was 66.1(±9.9) years, 80.5% men. More females were present in the T2D group (9.5% vs. 30.9%, p=0.005). </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The right coronary artery was most affected (44.1%), with 83.3% of CTOs showing Rentrop 3. Single-vessel disease occurred in 40.7%, and 69.5% achieved complete revascularization. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The mean follow-up was 47(±21) months, similar in both groups (p=0.924). Symptomatic relief (SR) was reported by 66.2% of patients. A significant increase in mean ejection fraction (EF) was observed after CTO recanalization (47.5% vs. 51.5%; p=0.001), which persisted in the T2D (p=0.029) and non-T2D (p=0.009) groups, with no significant difference between them (p=0.624). The SR group showed an important rise in EF following PCI (p=0.004), significant across both T2D (p=0.041) and non-T2D (p=0.050) groups, which was not observed in the non-SR group (p=0.175). Also, troponin variation was higher in patients without SR after PCI (p=0.011). This difference remained significant in the non-T2D group (p=0.005), but not in the T2D group (p=0.518).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Procedural complications occurred in 5.9% of cases, including distal vessel dissections (n=4), proximal dissections (n=2), and one case of acute limb ischemia, showing no significant difference between T2D and non-T2D groups (p=0.249). No in-hospital deaths were recorded. The all-cause mortality rate during the longest follow-up was similar in T2D (7.3%) and non-T2D (7.9%) groups (p=1.000). Although the T2D group showed a lower rate of repeated revascularization (4.7%) compared to the non-T2D group (8.5%), this difference was not statistically significant (p=0.679).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: Given that T2D patients with successful CTO revascularization have comparable periprocedural and long-term outcomes to the non-T2D population, our study suggests that PCI of CTOs, performed in highly experienced centers, constitutes a safe and effective treatment option in T2D patients unsuitable for CABG. Also, our findings advocate an improvement in left ventricular function following CTO-PCI, and suggest a potential link between EF gain and symptom relief.</span></span></p>
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