According to a recent study published in the October 1 issue of the “The American Journal of Cardiology,” percutaneous coronary intervention (or PCI) of chronic total occlusions (CTOs) is associated with reduced mortality in people with diabetes and can also reduce the need for coronary artery bypass grafting.
Headed by Bimmer E. Claessen, M.D., with the Cardiovascular Research Foundation of New York City, the study analyzed the long-term clinical outcomes after PCI of CTOs in patients who were known to be either diabetic or non-diabetic. The study used data from 1,742 patients who were classified according to whether they had been diagnosed with diabetes or not (1,347 were non-diabetic and 395 were diabetic). Study participants who underwent PCI of CTOs in the period between 1998 and 2007 were evaluated for five-year clinical outcomes. Patients were stratified according to several factors, including status of diagnosis of diabetes, successful versus failed CTO PCI, and for the use of drug-eluting (DES) versus bare-metal stents (BMS). The study participants received follow-up examinations for an average of three years.
The researchers identified similar procedural success both in patients who had diabetes and those who didn’t. In all, 96.4% of patients with diabetes and 94% of those without the disease received stent implantation after successful CTO PCI. It was also discovered that successful CTO PCI was associated with a significantly reduced long-term mortality risk in patients with diabetes, at 10.4% compared to 13%, as well as a significant reduction in requirements for coronary artery bypass grafting at 2.4% compared to 15.7%. Usage of drug-eluting stents versus bare-metal stents was associated with a decrease in target vessel revascularization in patients both with and without diabetes (17.6% for the former and 26.5% for the latter). Insulin-dependent diabetes was identified in multivariate analysis as a factor that independently predicted mortality in the cohort that had been diagnosed with diabetes.
“Successful CTO PCI in patients with DM was associated with a reduction in mortality and the need for coronary artery bypass grafting,” wrote the authors of the study.
Three of the researchers announced that they had interests associated with the study. Two of the authors associated with the study disclosed that they had financial ties to Cordis Corporation, while one other author disclosed financial ties to Boston Scientific Corporation.
Percutaneous coronary intervention (PCI), more commonly known as angioplasty, is a surgical procedure used to treat narrowed coronary arteries in the heart due to the buildup of cholesterol plaques. It has been shown to improve quality of life and to be more cost-effective than other procedures such as coronary artery bypass grafting in treating patients who have medically refractory myocardial ischemia.
The procedure is sometimes described as “balloon angioplasty” due to the use of an inflated balloon to crush the cholesterol plaque against the arterial walls and break it down. Although balloon inflation within the artery is generally performed in all angioplasties, the procedure typically includes other operatons such as atherectomy, the implantation of stents, and brachytherapy — the use of radiation to inhibit restenosis.
Stents are small mesh tubes that are implanted into the artery to ensure that it stays open. Stenting has been shown to reduce symptoms related to coronary artery disease in addition to reducing cardiac ischemia. Stents can be made of several different kinds of material. Stainless steel is the most commonly used material but it is not always compatible with the human body and steel stents sometimes result in restenosis and thrombosis.
