Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion

• Published in: Cardiovascular diabetology 2020-05, Vol.19 (1), p.59-59, Article 59
• Main Authors: Yang, Zhen Kun, Shen, Ying, Dai, Yang, Wang, Xiao Qun, Hu, Jian, Ding, Feng Hua, Zhang, Rui Yan, Lu, Lin, Shen, Wei Feng
• Format: Article
• Language: English
• Subjects: Angina; Angina pectoris; Cardiovascular disease; Cerebral blood flow; Chronic total occlusion; Clinical outcomes; Coronary collateral circulation; Coronary vessels; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Heart; Heart attacks; Heart surgery; Ischemia; Medical imaging; Medical prognosis; Original Investigation; Percutaneous coronary intervention; Prognosis; Stents; Studies; Success; Variables; Ventricle
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-020-01033-4

To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p = 0.008). At 13.5 ± 4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p = 0.034) and repeat revascularization (15.2% vs 25.5%, p = 0.026) was lower and the increase in LVEF (3.10% vs 1.80%, p = 0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p = 0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155,95% CI 1.290-3.599, p = 0.003) and repeat revascularization (HR 2.326, 95% CI 1.357-3.986, p = 0.002) in non-diabetic patients, but did not enter the model in those with T2DM. T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.