Author + information
- Received July 11, 2017
- Revision received August 10, 2017
- Accepted August 15, 2017
- Published online November 6, 2017.
- Adam C. Salisbury, MD, MSca,b,∗ (, )
- James Sapontis, MDc,
- J. Aaron Grantham, MDa,b,
- Mohammed Qintar, MDa,b,
- Kensey L. Gosch, MSa,
- William Lombardi, MDd,
- Dimitri Karmpaliotis, MDe,
- Jeffrey Moses, MDe,
- David J. Cohen, MD, MSca,b,
- John A. Spertus, MD, MPHa,b,
- Mikhail Kosiborod, MDa,b,
- for the OPEN CTO Study Group
- aSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- bUniversity of Missouri-Kansas City, Kansas City, Missouri
- cMonash Heart, Melbourne, Australia
- dUniversity of Washington School of Medicine, Seattle, Washington
- eColumbia University Medical Center, New York Presbyterian Hospital, New York, New York
- ↵∗Address for correspondence:
Dr. Adam C. Salisbury, Department of Cardiovascular Medicine, St. Luke's Mid America Heart Institute, 4401 Wornall Road, CV Research 9th Floor, Kansas City, Missouri 64111.
Objectives Few studies have evaluated the relationship of diabetes with technical success and periprocedural complications, and no studies have compared patient-reported health status after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without diabetes.
Background CTOs are more common in patients with diabetes, yet CTO PCI is less often attempted in patients with diabetes than in patients without. The association between diabetes and health status after CTO PCI is unknown.
Methods In the 12-center OPEN-CTO PCI registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Registry), patients with and without diabetes were assessed for technical success, periprocedural complications, and health status over 1 year following CTO PCI using the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Hierarchical modified Poisson regression was used to examine the independent association between diabetes and technical success, and hierarchical multivariable linear regression was used to assess the association between diabetes and follow-up health status.
Results Diabetes was common (41.2%) and associated with a lower crude rate of technical success (83.5% vs. 88.1%; p = 0.04). After adjustment, there was no significant difference between diabetic and nondiabetic patients (relative risk: 0.96, 95% confidence interval: 0.91 to 1.01). There were no significant differences in complication rates between patients with and without diabetes. Angina burden, quality of life, and overall health status scores were similar between diabetic and nondiabetic patients over 1 year.
Conclusions Although technical success was lower in patients with diabetes, this reflected lower success among patients with prior bypass surgery, without any significant difference in success rate after adjusting for prior bypass and disease complexity. CTO PCI complication rates are similar in diabetic and nondiabetic patients, and symptom improvement following CTO PCI is robust and of a similar magnitude regardless of diabetes status.
The OPEN-CTO study was funded by an unrestricted grant from Boston Scientific. Dr. Salisbury has received institutional research grants from Boston Scientific and Gilead. Dr. Sapontis has received speaking fees and honoraria from Boston Scientific. Dr. Grantham has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, Vascular Solutions, and Asahi Intecc; consulting fees from Boston Scientific and Vascular Solutions; institutional research grant support from Boston Scientific; institutional educational grant support from Abbott Vascular, Vascular Solutions, Boston Scientific, and Asahi Intecc; is a shareholder in Corindus Vascular Robotics and Insysiv; and is a part-time employee of Corindus Vascular Robotics. Dr. Lombardi has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Abiomed; has been a consultant for Vascular Solutions, Abbott Vascular, Boston Scientific, Abiomed, and Roxwood Medical; has equity in Roxwood Medical and Bridgepoint Medical; and his wife is an employee of Spectranetics. Dr. Karmpaliotis has received speaking fees, honoraria, and consulting fees from Abbott Vascular, Boston Scientific, Vascular Solutions, and Medtronic. Dr. Cohen has received institutional research grant support from Boston Scientific, Abbott Vascular, and Medtronic; and consulting fees from Medtronic and Abbott Vascular. Dr. Spertus has received research grants from Lilly, Novartis, and Abbott Vascular; has served as a consultant for Novartis, Cytokinetics, Bayer, and United Healthcare; owns the copyright to the SAQ; and has an equity interest in Health Outcomes Sciences. Dr. Kosiborod has served as a consultant or on the advisory board for AstraZeneca, Amgen, Eli Lilly, Boehringer Ingelheim, GlaxoSmithKline, Merck, Novo Nordisk, Eisai, Janssen, Intarcia, Sanofi, ZS Pharma, and Glytec; and has received research grant support from AstraZeneca and Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2017.
- Revision received August 10, 2017.
- Accepted August 15, 2017.
- 2017 American College of Cardiology Foundation