Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion

被引:14
作者
Yang, Zhen Kun [1 ]
Shen, Ying [1 ]
Dai, Yang [2 ]
Wang, Xiao Qun [1 ]
Hu, Jian [1 ]
Ding, Feng Hua [1 ]
Zhang, Rui Yan [1 ]
Lu, Lin [1 ,2 ]
Shen, Wei Feng [1 ,2 ]
机构
[1] Shanghai Jiao Tong Univ, Rui Jin Hosp, Dept Cardiol, Sch Med, Shanghai 200025, Peoples R China
[2] Shanghai Jiao Tong Univ, Inst Cardiovasc Dis, Sch Med, Shanghai 200025, Peoples R China
关键词
Chronic total occlusion; Diabetes mellitus; Coronary collateral circulation; Percutaneous coronary intervention; Prognosis; MYOCARDIAL-INFARCTION; MEDICAL THERAPY; SUCCESSFUL REVASCULARIZATION; PROCEDURAL OUTCOMES; PRIMARY ANGIOPLASTY; GLYCATED ALBUMIN; ARTERY-DISEASE; INTERVENTION; FLOW; CIRCULATION;
D O I
10.1186/s12933-020-01033-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. Results Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p = 0.008). At 13.5 +/- 4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p = 0.034) and repeat revascularization (15.2% vs 25.5%, p = 0.026) was lower and the increase in LVEF (3.10% vs 1.80%, p = 0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p = 0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155,95% CI 1.290-3.599, p = 0.003) and repeat revascularization (HR 2.326, 95% CI 1.357-3.986, p = 0.002) in non-diabetic patients, but did not enter the model in those with T2DM. Conclusions T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.
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页数:15
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