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Long-term clinical outcomes of patients with coronary chronic total occlusion treated with percutaneous coronary intervention versus medical therapy according to presence of diabetes mellitus.

Long-term clinical outcomes of patients with coronary chronic total occlusion treated with percutaneous coronary intervention versus medical therapy according to presence of diabetes mellitus.
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Choi KH, Yang JH, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH,


Choi KH, Yang JH, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH, (click to view)

Choi KH, Yang JH, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH,

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EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2017 02 07() pii EIJ-D-16-00737
Abstract
AIMS
The aim of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) treated with percutaneous coronary intervention (PCI) versus medical therapy (MT) according to the presence of diabetes mellitus.

METHODS AND RESULTS
A total of 845 patients without diabetes and 702 patients with diabetes were included from the Samsung Medical Center CTO registry. The inverse probability of treatment weighted (IPTW) method was used to adjust for confounding factors. The primary outcome was cardiac death. Median follow up duration was 46 (interquartile range: 23-71) months. Among the non-diabetes group, patients in the MT group had a higher rate of cardiac death (adjusted hazard ratio [HR] 2.54, 95% confidence interval [CI] 1.19-5.42, p=0.02) compared to those in the PCI group. For diabetes patients, there was no significant difference between the two groups in rate of cardiac death (adjusted HR 1.09, 95% CI 0.62-1.90, p=0.77). There was a significant interaction between diabetes and cardiac death (interaction p=0.03). After performing IPTW methods, a similar result was observed (interaction p<0.001). CONCLUSIONS
For treatment of CTO, PCI may reduce the risk of cardiac mortality in non-diabetic patients but not in diabetic patients.

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