Objectives: The prognosis of patients with chronic total occlusion (CTO) and diabetes mellitus treated with percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation is unknown.
Methods: We compared the 12-month outcomes of 52 diabetic patients with CTO after successful PCI who underwent DES implantation with that of 47 patients with diabetes and CTO previously treated with bare-metal stents (BMS). Death, myocardial infarction and repeat PCI or coronary artery bypass surgery were considered as a combined primary endpoint.
Results: At 1-year follow up, the primary endpoint occurred in 6% (n = 3) of patients treated with DES and 23% (n = 11) of the patients treated with BMS (p = 0.01). One patient in the DES group and 3 patients in the BMS group died during follow up (p = 0.26). Stepwise logistic regression analysis identified DES (odds ratio [OR] = 12.9, 95% confidence interval [CI] 2.90-57.5; p = 0.0004) and final minimal lumen diameter (odds ratio [OR] = 10.1, 95% CI 1.81-56.4; p = 0.01) as independent correlates of major adverse cardiac events (MACE) at follow up.
Conclusions: In patients with chronic total occlusion, DES were superior to bare-metal stents in reducing the MACE and should be considered a preferred treatment strategy for patients with diabetes and CTO undergoing PCI.