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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM.

Recent Findings

Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox).

Summary

CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CTO:

Chronic total occlusion

DES:

Drug-eluting stent

DM:

Diabetes mellitus

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

RCT:

Randomized controlled trial

TLR:

Target lesion revascularization

TVR:

Target vessel revascularization

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Authors and Affiliations

  1. Division of Cardiology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Juan F. Iglesias, Sophie Degrauwe, Fabio Rigamonti, Stéphane Noble & Marco Roffi

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  1. Juan F. Iglesias
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Correspondence to Marco Roffi.

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Conflict of Interest

Fabio Rigamont and Stéphane Noble declare that they have no conflict of interest.

Juan F. Iglesias reports institutional grant/research support from Biotronik, Astra Zeneca, Terumo, and Philips Volcano, consultant fees from Biotronik, Terumo, and Cardinal Health, and honoraria/speaker’s fee from Biotronik, Terumo, Medtronic, Astra Zeneca, and Philips Volcano.

Sophie Degrauwe reports educational grants from Biotronik.

Marco Roffi reports institutional research funds from Terumo, Abbott Vascular, Biotronik, Medtronic, and Boston Scientific.

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Iglesias, J.F., Degrauwe, S., Rigamonti, F. et al. Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox. Curr Cardiol Rep 21, 9 (2019). https://doi.org/10.1007/s11886-019-1091-2

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