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Current Cardiology Reports
Published in: Current Cardiology Reports 2/2019

01-02-2019 | Myocardial Infarction | Ischemic Heart Disease (D Mukherjee, Section Editor)

Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox

Authors: Juan F. Iglesias, Sophie Degrauwe, Fabio Rigamonti, Stéphane Noble, Marco Roffi

Published in: Current Cardiology Reports | Issue 2/2019

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Abstract

Purpose of Review

Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM.

Recent Findings

Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox).

Summary

CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
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Metadata
Title
Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox
Authors
Juan F. Iglesias
Sophie Degrauwe
Fabio Rigamonti
Stéphane Noble
Marco Roffi
Publication date
01-02-2019
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 2/2019
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-019-1091-2

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