scholarly journals Glycemic Control Status and Long-Term Clinical Outcomes in Diabetic Chronic Total Occlusion Patients: An Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Xuehui Zhang ◽  
Maoxiao Nie ◽  
Xue Chen ◽  
Zhe Liang ◽  
Quanming Zhao
Keyword(s):  
Glycemic Control ◽  
Propensity Score ◽  
Chronic Total Occlusion ◽  
Cox Regression ◽  
Glycosylated Hemoglobin ◽  
Major Adverse Cardiovascular Events ◽  
Good Glycemic Control ◽  
Total Occlusion ◽  
Clinical Prognosis ◽  
Repeat Revascularization

Background. Whether good glycemic control can result in clinical benefits for diabetic chronic total occlusion (CTO) patients is still a matter of debate. Methods. We studied 1029 diabetic CTO patients. Based on one-year glycosylated hemoglobin A (HbA1c) levels, we assigned the patients into 2 groups: HbA1c<7% group (n = 448) and HbA1c ≥ 7% group (n = 581). We further subdivided the patients into the successful CTO revascularization (CTO-SR) and nonsuccessful CTO revascularization (CTO-NSR) groups. Kaplan–Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiovascular events (MACE) and other endpoints. Results. There were no significant differences between the groups in terms of most endpoints in the overall patients. After propensity score-matched analysis, patients with HbA1c < 7.0 tended to be superior in terms of MACE, which was mainly attributed to repeat revascularization but the other endpoints. Furthermore, the benefit of the HbA1c < 7 group was more prominent among patients with CTO-NSR in terms of MACE, repeat revascularization, and target vessel revascularization (TVR); and the improvement of the HbAc1 < 7 group was more prominent among patients without chronic heart failure (CHF) ( P = 0.027 ). Conclusions. HbA1c < 7.0 was associated with a reduced incidence of MACE, which was mainly attributed to a reduction in repeat revascularization. Good glycemic control can improve diabetic CTO patients’ clinical prognosis, especially in CTO-NSR patients.

scholarly journals Glycemic Control Status and Long-term Clinical Outcomes in Diabetic Chronic total occlusion patients: An Observational Study

2021 ◽  
Author(s):  
Xuehui Zhang ◽  
Maoxiao Nie ◽  
Xue Chen ◽  
Zhe Liang ◽  
Quanming Zhao
Keyword(s):  
Glycemic Control ◽  
Propensity Score ◽  
Chronic Total Occlusion ◽  
Cox Regression ◽  
Glycosylated Hemoglobin ◽  
Major Adverse Cardiovascular Events ◽  
Good Glycemic Control ◽  
Total Occlusion ◽  
Clinical Prognosis ◽  
Repeat Revascularization

Abstract Background: Whether good glycemic control can result in clinical benefits for diabetic chronic total occlusion (CTO) patients are limited and controversial.Methods: We assigned the enrolled patients into 2 groups based on one-year glycosylated hemoglobin A (HbA1c) levels: HbA1c<7% group (n=448) and HbA1c≥7% group (n=581). We further subdivided the patients into the successful CTO revascularization (CTO-SR) and non-successful CTO revascularization (CTO-NSR) groups. Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiovascular events (MACE) and other endpoints.ResultsThere were no significant differences between the groups in terms of the most endpoints in the overall patients. After propensity score-matched analysis, patients with HbA1c < 7.0 tended to be superior in terms of MACE, which was mainly attributed to repeat revascularization but the other endpoints. What’s more, the benefit of the HbA1c <7 group was more prominent among patients with CTO-NSR in terms of MACE, repeat revascularization and target vessel revascularization (TVR). And, the improvement of the HbAc1＜7 group was more prominent among patients without chronic heart failure (CHF) (P=0.027). Conclusions: HbA1c <7.0 was associated with a reduced incidence of MACE, which was mainly attributed to a reduction in repeat revascularization. Well glycemic control can improve diabetic CTO patients’ clinical prognosis, especially in CTO-NSR patients.Trial registration: The present study was approved by the Clinical Research Ethics Committee of Beijing Anzhen Hospital, Capital Medical University (No:2018008X). Informed consent was exempt by the committee.

scholarly journals Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

scholarly journals Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.K Park ◽  
S.H Choi ◽  
J.M Lee ◽  
J.H Yang ◽  
Y.B Song ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT). Purpose To compare 10-year clinical outcomes between OMT and PCI in CTO patients. Methods Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death. Results In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p&lt;0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant). Conclusions As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients. Cardiac death in matched population Funding Acknowledgement Type of funding source: None

scholarly journals Description of a methodological approach to verify the outcome-optimization of tailored therapeutic choices and test application to PCI vs. CABG.

2012 ◽  
Vol 2 (2) ◽  
pp. 47
Author(s):  
Stefano Di Bartolomeo ◽  
Paolo Guastaroba ◽  
Daniela Fortuna ◽  
Rossana De Palma ◽  
Roberto Grilli
Keyword(s):  
Propensity Score ◽  
Coronary Disease ◽  
Decision Process ◽  
Cox Regression ◽  
Bypass Graft ◽  
Medical Decision ◽  
Scientific Uncertainty ◽  
Favorable Effect ◽  
Ratio Test ◽  
Repeat Revascularization

Background. The decision process between Percutaneous Coronary Intervention (PCI) and Bypass Graft Surgery (CABG) is based on inconclusive evidence. Yet, it is generally regarded as capable of optimizing patient outcomes. Objectives. To verify this belief through a statistical approach investigating effect modification by propensity score (PS). Methods The probability of receiving PCI as the revascularisation strategy – PS - was calculated for all the 11750 patients with severe coronary disease who underwent coronary revascularization between 2002 and 2008 in Emilia-Romagna, Italy. Long-term risks of PCI vs. CABG for death, myocardial infarction, repeat revascularization and stroke were calculated by Cox regression in each decile of PS. The homogeneity of the Hazard Ratios (HR) across deciles was assessed with a likelihood ratio test and by visual inspection. Results. Repeat revascularization was the only outcome that significantly differed across deciles of PS (p=0.05) and whose trend supported a favorable effect of the decision process. Conclusions In agreement with the current scientific uncertainty, but contrary to common opinion, the medical decision process between PCI and CABG based on demographic and clinical factors is marginally capable of optimizing the post-procedural outcomes. The proposed methodology is limited by the assumption that clinicians considered only the variables that entered the PS calculation. Keywords Outcome And Process Assessment (Health Care), Coronary Disease, Coronary Artery Bypass, Angioplasty, Patient Selection, Propensity Score

scholarly journals A sex stratified long-term clinical outcome analysis in Coronary chronic total occlusion patients

2020 ◽  
Author(s):  
Xuhe Gong ◽  
Li Zhou ◽  
Xiaosong Ding ◽  
Hui Chen ◽  
hongwei li
Keyword(s):  
Clinical Outcomes ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Abdominal Circumference ◽  
Outcome Analysis ◽  
Total Occlusion ◽  
Hazard Ratios ◽  
History Of

Abstract Background: Differences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI.Methods: A total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. 300 patients were revascularized by PCI and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; Hazard ratios were generated using multivariable Cox regression.Results: Women represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men, however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p=0.234) and cardiac death (3.1% vs 5.6%, p=0.202). Predictors of CTO recanalization revealed that Age＜65years, absence of prior CABG, no history of DM and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE.Conclusion: Our study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.

Percutaneous Coronary Intervention Offers Survival Benefit to Stable Patients With One Single Chronic Total Occlusion and Diabetes: A Propensity Score–Matched Analysis

Angiology ◽  
2019 ◽  
Vol 71 (2) ◽  
pp. 150-159 ◽  
Author(s):  
Yunfeng Yan ◽  
Fei Yuan ◽  
Hong Liu ◽  
Feng Xu ◽  
Min Zhang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Treatment Strategy ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Total Occlusion ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary ◽  
Patients With Diabetes

Studies on chronic total occlusion (CTO) treatment strategy in stable patients have reported conflicting results. We focused on stable diabetic patients with a single CTO (other vessels have been successfully treated before). We attempted to identify which strategy (percutaneous coronary intervention [PCI] or medical therapy [MT]) is optimal; 545 patients were selected from a total of 39 952 patients. Based on the initial treatment strategy, we assigned patients to either the PCI or MT group. The primary end point was a major adverse cardiac event (MACE). After a median follow-up of 45 months (interquartile range: 25.7-79.2 months), we observed (1) no difference in MACE and myocardial infarction between groups, (2) multivariate analysis showed that PCI group was superior to MT group in cardiac death (hazard ratio: 4.758 (1.698-13.334); P = .003) and all-cause death (2.767 [1.157-6.618]; P = .022). The superiority was consistent in propensity score–matched analysis, and (3) a failed PCI group was not associated with higher risks in the clinical end points, except for target vessel revascularization, compared with MT. We concluded that for stable patients with diabetes and one single CTO, initial PCI strategy tended to offer patients survival benefits compared with MT.

scholarly journals A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Xuhe Gong ◽  
Li Zhou ◽  
Xiaosong Ding ◽  
Hongwei Li ◽  
Hui Chen
Keyword(s):  
Clinical Outcomes ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Abdominal Circumference ◽  
Outcome Analysis ◽  
Total Occlusion ◽  
Hazard Ratios ◽  
History Of

Abstract Background Differences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI. Methods A total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression. Results Women represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE. Conclusion Our study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.

scholarly journals Thrombotic vs. Bleeding Events of Interruption of Dual Antiplatelet Therapy within 12 Months among Patients with Stent-Driven High Ischemic Risk Definition following PCI

2022 ◽  
Vol 2022 ◽  
pp. 1-15
Author(s):  
Hao-Yu Wang ◽  
Bo Xu ◽  
Chen-Xi Song ◽  
Chang-Dong Guan ◽  
Li-Hua Xie ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Bleeding Events ◽  
Risk Criteria ◽  
Clinical Events

Background. There is a paucity of real-world data regarding the clinical impact of dual antiplatelet therapy (DAPT) interruption (temporary or permanent) among patients at high ischemic risk. The aim of this study was to assess the risk of cardiovascular events after interruption of DAPT in high-risk PCI population. Methods. This study used data from the Fuwai PCI registry, a large, prospective cohort of consecutive patients who underwent PCI. We assessed 3,931 patients with at least 1 high ischemic risk criteria of stent-related recurrent ischemic events proposed in the 2017 ESC guidelines for focused update on DAPT who were free of major cardiac events in the first 12 months. The primary ischemic endpoint was 30-month major adverse cardiac and cerebrovascular events, and the key safety endpoints were BARC class 2, 3, or 5 bleeding and net adverse clinical events. Results. DAPT interruption within 12 months occurred in 1,122 patients (28.5%), most of which were due to bleeding events or patients’ noncompliance to treatment. A multivariate Cox regression model, propensity score (PS) matching, and inverse probability of treatment weighting (IPTW) based on the propensity score demonstrated that DAPT interruption significantly increased the risk of primary ischemic endpoint compared with prolonged DAPT (3.9% vs. 2.2%; Cox-adjusted hazard ratio (HR): 1.840; 95% confidence interval (CI): 1.247 to 2.716; PS matching-HR: 2.049 [1.236–3.399]; IPTW-adjusted HR: 1.843 [1.250–2.717]). This difference was driven mainly by all-cause death (1.8% vs. 0.7%) and MI (1.3% vs. 0.5%). Furthermore, the rate of net adverse clinical events (4.9% vs. 3.2%; Cox-adjusted HR: 1.581 [1.128–2.216]; PS matching-HR: 1.639 [1.075–2.499]; IPTW-adjusted HR: 1.554 [1.110–2.177]) was also higher in patients with DAPT interruption (≤12 months), whereas no significant differences between groups were observed in terms of BARC 2, 3, or 5 bleeding. These findings were consistent across various stent-driven high-ischemic risk subsets with respect to the primary ischemic endpoints, with a greater magnitude of harm among patients with diffuse multivessel diabetic coronary artery disease. Conclusions. In patients undergoing high-risk PCI, interruption of DAPT in the first 12 months occurred infrequently and was associated with a significantly higher adjusted risk of major adverse cardiovascular events and net adverse clinical events. 2017 ESC stent-driven high ischemic risk criteria may help clinicians to discriminate patient selection in the use of long-term DAPT when the ischemic risk certainly overcomes the bleeding one.

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