Influence of total coronary occlusion on clinical outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)

Abdulla A. Damluji, Sydney F. Pomenti, Archana Ramireddy, Mohammed S. Al-Damluji, Carlos E. Alfonso, Alan H. Schob, Steven P. Marso, Ian C. Gilchrist, Mauro Moscucci, David E. Kandzari, Mauricio G. Cohen

Research output: Contribution to journalArticle

Abstract

Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes, who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone according to the presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972 patients (41%) had CTO of coronary arteries. Of those, 482 (41%) and 490 (41%) were in the PR with IMT versus IMT only groups, respectively. In the PR group, patients with CTO were more likely to be selected for the coronary artery bypass grafting stratum (coronary artery bypass grafting 62% vs percutaneous coronary intervention 31%, p <0.001). Compared to the non-CTO group, patients with CTO had more abnormal Q wave, abnormal ST depression, and abnormal T waves. The myocardial jeopardy score was higher in the CTO versus non-CTO group (52 [36 to 69] vs 37 [21 to 53], p <0.001). After adjustment, 5-year mortality rate was significantly higher in the CTO group in the entire cohort (hazard ratio [HR] 1.35, p = 0.013) and in patients with CTO managed with IMT (HR 1.46, p = 0.031). However, the adjusted risk of death was not increased in patients managed with PR (HR 1.26, p = 0.180). In conclusion, CTO of coronary arteries is associated with increased mortality in patients treated medically. However, the presence of a CTO may not increase 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.

Original languageEnglish (US)
Pages (from-to)1031-1038
Number of pages8
JournalAmerican Journal of Cardiology
Volume117
Issue number7
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Coronary Occlusion
Angioplasty
Coronary Artery Bypass
Coronary Disease
Mortality
Coronary Vessels
Diabetes Mellitus
Social Adjustment
Percutaneous Coronary Intervention
Therapeutics
Group Psychotherapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Influence of total coronary occlusion on clinical outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial). / Damluji, Abdulla A.; Pomenti, Sydney F.; Ramireddy, Archana; Al-Damluji, Mohammed S.; Alfonso, Carlos E.; Schob, Alan H.; Marso, Steven P.; Gilchrist, Ian C.; Moscucci, Mauro; Kandzari, David E.; Cohen, Mauricio G.

In: American Journal of Cardiology, Vol. 117, No. 7, 01.04.2016, p. 1031-1038.

Research output: Contribution to journalArticle

Damluji, AA, Pomenti, SF, Ramireddy, A, Al-Damluji, MS, Alfonso, CE, Schob, AH, Marso, SP, Gilchrist, IC, Moscucci, M, Kandzari, DE & Cohen, MG 2016, 'Influence of total coronary occlusion on clinical outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial)', American Journal of Cardiology, vol. 117, no. 7, pp. 1031-1038. https://doi.org/10.1016/j.amjcard.2015.12.047
Damluji, Abdulla A. ; Pomenti, Sydney F. ; Ramireddy, Archana ; Al-Damluji, Mohammed S. ; Alfonso, Carlos E. ; Schob, Alan H. ; Marso, Steven P. ; Gilchrist, Ian C. ; Moscucci, Mauro ; Kandzari, David E. ; Cohen, Mauricio G. / Influence of total coronary occlusion on clinical outcomes (from the Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial). In: American Journal of Cardiology. 2016 ; Vol. 117, No. 7. pp. 1031-1038.
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abstract = "Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes, who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone according to the presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972 patients (41{\%}) had CTO of coronary arteries. Of those, 482 (41{\%}) and 490 (41{\%}) were in the PR with IMT versus IMT only groups, respectively. In the PR group, patients with CTO were more likely to be selected for the coronary artery bypass grafting stratum (coronary artery bypass grafting 62{\%} vs percutaneous coronary intervention 31{\%}, p <0.001). Compared to the non-CTO group, patients with CTO had more abnormal Q wave, abnormal ST depression, and abnormal T waves. The myocardial jeopardy score was higher in the CTO versus non-CTO group (52 [36 to 69] vs 37 [21 to 53], p <0.001). After adjustment, 5-year mortality rate was significantly higher in the CTO group in the entire cohort (hazard ratio [HR] 1.35, p = 0.013) and in patients with CTO managed with IMT (HR 1.46, p = 0.031). However, the adjusted risk of death was not increased in patients managed with PR (HR 1.26, p = 0.180). In conclusion, CTO of coronary arteries is associated with increased mortality in patients treated medically. However, the presence of a CTO may not increase 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.",
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AU - Al-Damluji, Mohammed S.

AU - Alfonso, Carlos E.

AU - Schob, Alan H.

AU - Marso, Steven P.

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