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CTOs linked to mortality in patients with CAD, diabetes
In patients with CAD and diabetes, the presence of chronic total occlusion of coronary arteries was linked to increased mortality in patients undergoing medical treatment, but may not yield increased mortality in patients who undergo revascularization, according to recent findings.
In a post-hoc analysis of the BARI 2D trial, researchers evaluated 2,368 patients with CAD and type 2 diabetes who were enrolled in the trial. All participants in BARI 2D were randomly assigned prompt revascularization with intensive medical therapy or intensive medical therapy alone.
Of the overall patient population, 972 patients had CTOs. Of those, 482 were randomly assigned prompt revascularization with intensive medical therapy and 490 were treated with intensive medical therapy alone.
Of the patients assigned to the revascularization group, those with a CTO were more likely to undergo CABG vs. PCI (62% vs. 31%; P < .001). Compared with patients without a CTO, those with a CTO more frequently had abnormal Q wave (24.7% vs. 14.9%; P < .001), abnormal ST depressions (22.7% vs. 13.7%; P < .001) and abnormal T waves (48.6% vs. 38.2%; P < .001). Patients with a CTO also had a higher likelihood of abnormal baseline left ventricular systolic function (left ventricular ejection fraction < 50%: CTO, n = 229 vs. non-CTO, n = 171; P < .001). Compared with patients without CTOs, patients in the CTO group had a higher myocardial jeopardy score (52 vs. 37; P < .001). At more than 5 years of follow-up, Kaplan-Meier survival curve showed an increased risk for all-cause mortality in patients with significant disease and CTO (HR = 1.35; 95% CI, 1.08-1.78). Within the intensive medical therapy group, CTO with significant disease was associated with significantly higher risk for all-cause mortality (HR = 1.47; 95% CI, 1.04-2.05). However, univariate and multivariate analyses within the prompt revascularization group did not reveal an association between CTO status with significant disease and increased all-cause mortality vs. patients without CTO (HR = 1.26; P = .18).
“Our study is the first to evaluate the effects of revascularization specifically in patients with diabetes with stable ischemic heart disease based on the presence or absence of CTOs,” the researchers wrote. “We found no excess risk of mortality or MACE in CTO in patients managed with revascularization and [intensive medical therapy].” – by Jennifer Byrne
Disclosure: Two of the researchers report consulting for Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Novo Nordisk, St. Jude and Terumo.