Abstract 18288: Prompt Revascularizations vs. Intensive Medical Therapy for Chronic Total Occlusions of Coronary Arteries: Results from BARI-2D Trial
Introduction: Our aim was to evaluate the long-term outcomes of chronic total occlusions (CTO) in diabetic patients receiving revascularization and intensive medical therapies.
Methods: We evaluated patients with multivessel coronary heart disease (CHD) and diabetes mellitus who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Patients were categorized according to the presence or absence of CTO in both groups. Primary end points were death and a composite of death, MI, or stroke (MACE). We used multivariate Cox regression analysis to evaluate the independent effect of CTO on clinical outcomes by treatment groups.
Results: Of 2,368 patients enrolled in the trial, 972 (41%) had CTO of coronary arteries. Of those, 482 (41%) and 490 (41%) were in the PR vs. IMT groups, respectively. In the PR group, patients with CTO were more likely to be assigned to the CABG stratum of the trial (CABG 62% vs. PCI 41%, p <0.001). There were no differences in age, BMI, dyslipidemia, or serum creatinine in patients with and without CTO. Patients with CTO were more likely to be Caucasian males, with history of MI, CHF, and prior revascularization. Compared to non-CTO group, patients with CTO had more abnormal Q wave (25% vs. 15%, p < 0.001), abnormal ST depression (23% vs. 14%, p < 0.001), and abnormal T waves (49% vs. 38%, p < 0.001). The myocardial jeopardy score was higher in the CTO vs. non-CTO group (CTO: 52 [36, 69]; Non-CTO: 37 [21, 53], p <0.001). After adjustment, the 7-year mortality was significantly higher in the CTO vs. non-CTO group in entire cohort (HR 1.35, p =0.013). Similarly, the 7-year mortality was significantly elevated in patients with CTO (vs. no CTO) in the IMT group (HR 1.45, p =0.031). However, in the PR group, there was no increased risk of mortality in the multivariable model (HR 1.26, p =0.180).
Conclusion: CTO of coronary arteries carries a high mortality risk in patients treated with intensive medical therapy, while it does not appear to increase the risk of mortality in patients treated with revascularization. Larger randomized trials are needed to evaluate the effects of revascularization on long-term survival in patients with CTO.
- Coronary artery disease
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
- Coronary heart disease
Author Disclosures: A. Damluji: None. A. Ramireddy: None. M.S. Al-Damluji: None. L. Otalvaro: None. G.R. Marzouka: None. C.E. Alfonso: None. A.H. Schob: None. A.W. Heldman: None. I.C. Gilchrist: None. M. Moscucci: None. D.E. Kandzari: None. M.G. Cohen: None.
- © 2014 by American Heart Association, Inc.