Percutanous Revascularization of Chronic Total Occlusion of Diabetic Patients at Iraqi Center for Heart Diseases, A Single Center Experience 2012.

Abstract

I want to evaluate the influence of (DM) on the results of (PCI) of patents with (CTO) and to compare that with the results in non diabetic patients.

We had prospectively studied 150 consecutive cases of (CTO) who had (PCI) at Iraqi center for heart diseases-Baghdad/Iraq for the period January –December 2012. All patients were symptomatic. We recorded patients baseline characteristics, which coronary artery involved, the segment/s involved, and whether the patient diabetic or not and impact of these parameters on the hospital outcome of the intervention. We also looked at influence of (HTN), (HLP), (SM), and (PFH) for ischemic heart diseases, on the outcome of the intervention as well.

Success of revascularization of chronic total occlusion by percutaneous coronary intervention was similar in both sexes (male 69.4% female 72.4%).  Intervention was successful in 40 out of 55 patients with diabetes mellitus (72.7%) which was identical to those without diabetes mellitus (66 patients out of 95 patients (69.47%).The success in diabetic and non diabetic groups in the absence of other risk factors was 64.2 % and 62% while in the presence of these risk factors it was 73.1% and 71.2 % respectively.

In 11 out of the15 patients with diabetes failed intervention was attributed to inability to pass the wire (73.3 %.) compared to 23 out of the 29 nondiabetic patients (79.3%). While failure to pass the balloon was identical in both groups (13.3% compared 13.7 and failure to pass a stent while it was not reported compared to 3.4% in both diabetic and non-diabetic patients respectively.

  As far as failure failure of procedure, passing the wire into a false lumen occurred in one patient (6.6%) of diabetic group and not reported in the non diabetics while creation of perforation had occurred in one patient (6.6%) in diabetics and also in one patient (3.45) in non diabetic patient.

Successful revascularization has led to a prompt relieve of symptoms; angina and improved exercise tolerance as well as enhanced left ventricular function equally in both groups.

Regarding CTO-PCI, there was no much difference between success in diabetic and non diabetic patients. The beneficial effect of successful recanalization of CTO on overall survival free of major adverse events was clearly apparent to be irrespective of diabetic status. Presence of additional risk factors other than diabetes mellitus has no additional burden on the results of such interventions.CTO-PCI should be done in all patients with prognosticaly significant ischemia or heart failure with significant viability.