PCI success, complications similar in patients with, without diabetes

Patients with diabetes who underwent percutaneous coronary intervention represented nearly half of those undergoing the surgery in a U.S. cohort between 2012 and 2015, and had similar complications and success rates as patients without diabetes, study data show.

“Diabetes has been associated with multivessel coronary artery disease, arterial calcification, high risk of peripheral artery disease and impaired left ventricular systolic function,” Jose Roberto Martinez-Parachini, MD, of the VA North Texas Healthcare System and UT Southwestern Medical Center in Dallas, and colleagues wrote. “There are few studies investigating whether the presence of diabetes mellitus affects the procedural outcomes of chronic total occlusion; this was the focus of the present study.”

Researchers analyzed the records of 1,308 patients who underwent percutaneous coronary intervention for chronic total occlusion at 11 health care centers throughout the United States between May 2012 and September 2015.

Nearly half (44.6%) of patients had diabetes, and 84% were men. Mean age was 66 years. Patients with diabetes were more likely to have had prior heart failure than those without diabetes (35% vs. 22%; P = .0001), as well as peripheral arterial disease (19% vs. 13%; P = .002) and coronary artery bypass graft surgery (38% vs. 31%; P = .006). Patients with diabetes also had a higher BMI (31 kg/m² vs. 29 kg/m²), but had similar Japan–chronic total occlusion scores as those without diabetes (2.6 vs. 2.5; P = .82).

The researchers wrote that patients with diabetes had similar technical (90.7% vs. 90.3%; P = .8) and procedural (89.3% vs. 89.1%; P = .9) success rates as patients without diabetes, as well as similar final successful crossing strategies (retrograde: 30% vs. 27.7%; antegrade wire escalation: 45.8% vs. 47.2%; antegrade dissection and re-entry: 24% vs. 25%; P = .66).

Thirty (2.4%) patients experienced major adverse cardiovascular events, with similar occurrence in both groups of patients. The same was true of several other adverse events, Martinez-Parachini and colleagues reported, including myocardial infarction (1.3% vs. 0.5%; P = .11), stroke (0.4% vs. 0.1%; P = .4), emergency percutaneous coronary intervention (0.3% for both; P = .82), emergency pericardiocentesis (0.6% for both; P = .99) and death (0.4% vs. 0.3%; P = .51). No patients experienced emergency coronary artery bypass.

“In summary, percutaneous coronary intervention was performed for chronic total occlusion in people with and without diabetes mellitus with equally high success and equally low complication rates,” Martinez-Parachini and colleagues wrote. – by Andy Polhamus

Disclosure: Martinez-Parachini reports no relevant financial disclosure. Please see the full study for a complete list of all other authors’ relevant financial disclosures.