Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus

Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62–2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85–0.99 and p=0.013, HR 0.96, 95% CI 0.93–0.99, respectively). T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization. As oclusões totais crónicas (CTO) são achados comuns em doentes com diabetes tipo 2 (DM2). A indicação para revascularização percutânea (PCI) e o seu benefício clínico permanecem controversos. Este estudo foi desenhado para tentar responder a esta questão. Estudo de coorte retrospetivo com colheita de dados prospetiva, realizada em doentes com CTO submetidos a PCI entre 2019-2020. Formados dois grupos (DM2 e não-DM2). O outcome primário foi definido como a recorrência de sintomas de angor e/ou insuficiência cardíaca e os outcomes secundários a ocorrência de enfarte do miocárdio e mortalidade por todas as causas. Análise com 177 doentes, idade média de 65±11 anos e 82,5% do sexo masculino. O outcome primário ocorreu em 16,6% dos doentes, sem diferença entre os grupos (não-DM2 13,6% versus DM2 21,2%, p=0,194) em dois anos. A recorrência de angor foi signific