High serum levels of CML are associated with poor coronary collateralization in type 2 diabetic patients with chronic total occlusion of coronary artery

Background: The formation of advanced glycation end-products (AGEs) is a crucial risk factor for the pathogenesis of cardiovascular diseases. We investigated whether N-e-carboxy-methyl-lysine (CML), a major form of AGEs in vivo, was associated with poor coronary collateral vessel (CCV) formation in patients with type 2 diabetes mellitus (T2DM) and chronic total occlusion (CTO) of coronary artery.Methods: This study consisted of 242 T2DM patients with angiographically documented CTO. Blood samples were obtained and demographic/clinical characteristics were documented. The collateralization of these patients was defined according to Rentrop score. Receiver operating characteristic (ROC) curve and multivariable regression analysis were performed.Results: 242 patients were categorized into poor CCV group (Rentrop score 0 and 1)(n = 107) and good CCV group (Rentrop score 2 and 3)(n = 135). Serum CML levels were significantly higher in poor CCV group (110.0 ± 83.35 ng/ml) than in good CCV group (62.95 ± 58.83 ng/ml, P<0.001). Moreover, these CML levels were also significantly different across the Rentrop score 0, 1, 2 and 3 groups (P <0.001). In ROC curve for ascertaining poor CCV, AUCs were 0.70 (95% CI 0.64-0.77) for CML. In multivariable logistic regression, CML levels (P<0.001) remained independent determinants of poor CCV after adjustment of traditional risk factors. Conclusions: This study suggests that higher CML levels are associated to poor CCV in T2DM patients with CTO. Inhibition of AGEs including CML is a strategy in antagonizing poor CCV in diabetic patients.

Ticagrelor Versus Clopidogrel in The Treatment of Elderly Chinese Chronic Total Occlusion Patients Undergoing PCI

Background: Taking thrombosis and bleeding risks into consideration, little real world study data is available to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in elderly Chinese chronic total occlusion (CTO) patients. Methods: We assigned 504 CTO patients aged ≥75 years who successfully underwent PCI from December 2009 to May 2020. The patients were randomized to Clopidogrel and Ticagrelor group and received DAPT for up to 12 months. Efficacy endpoints were evaluated by major adverse cardiac events (MACE) consisting of all-cause death, nonfatal myocardial infarction (MI) and clinically driven revascularization. The safety endpoints were recorded as the incidence of Bleeding Academic Research Consortium (BARC) bleeding. Results: Patients in Clopidogrel group were older, they had a higher percentage of BMI, diastolic blood pressure and HDL-C than those in Ticagrelor group. Clopidogrel group had a lower percentage of hyperlipidemia, prior PCI, glucose, TG and LDL-C. No significant difference was found as to the Angiographic and procedural characteristics (P＞0.05 for all). After 12 months' follow-up, the incidence of MACE (12.19% vs. 11.04%, P=0.763) and bleeding (9.38% vs. 13.64%, P=0.205) had no significant difference. After clinical characteristics balanced matching by IPTWs model, we found that Ticagrelor had an unfavorable effect on reducing the incidence of bleeding with the IPTWs model (IPTW-OR, 1.81, 95% CI: 1.18-2.76, P=0.006). Conclusions: This clinical study demonstrated that Clopidogrel should be recommended to elderly CTO patients after PCI, especially those with a high bleeding risk. Trial registration: The study protocol was approved by the Ethics Committee of Air Force Medical University (KY20172019-1).