Comparison of 12-month clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion lesions: a multicenter study

OBJECTIVE This study aimed to compare 1-year clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion (CTO) lesions. METHODS A total of 2865 patients (age 62.82±10.64 years; 74.0% men) undergoing percutaneous coronary intervention for CTO were analyzed. The patients were classified as diabetic (n=977) or nondiabetic (n=1888). One-year clinical outcomes were compared between the two groups. RESULTS One year after percutaneous coronary intervention, 241 (8.4%) patients developed major adverse cardiac events (MACEs). Target lesion revascularization (TLR), target vessel revascularization (TVR), TLR-MACEs, and total MACEs were more common in diabetics than in nondiabetics (6.1 vs. 3.9%, P=0.021; 7.2 vs. 4.8%, P=0.023; 7.7 vs. 5.5%, P=0.017; and 10.3 vs. 7.7%, P=0.011; respectively). In multivariate analysis, diabetes mellitus was an independent predictor for 1-year TLR (odds ratio: 2.201, P=0.001) and total MACEs (odds ratio: 1.677, P=0.002). Among diabetic patients, total death, TLR, TVR, TLR-MACEs, TVR-MACEs, and total MACEs were more common in patients who used insulin than in those who did not (6.1 vs. 1.9%, P=0.018; 11.3 vs. 4.6%, P=0.007; 12.2 vs. 5.9%, P=0.025; 14.8 vs. 5.9%, P=0.003; 16.5 vs. 8.0%, P=0.008; and 17.4 vs. 9.2%, P=0.012, respectively). Insulin use was an independent predictor for total death, 12-month TLR, TVR, TLR-MACEs, TVR-MACEs, and total MACEs. CONCLUSION This study identified diabetes mellitus as an independent risk factor for 1-year TLR and total MACEs in patients with CTO lesions.