Impact of diabetes mellitus on all and successful percutaneous coronary intervention outcomes for chronic total occlusions: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Diabetes mellitus (DM) is a leading cause of morbidity and mortality globally and can affect numerous vital organs, including the kidney, liver, heart, nervous system, and vascular system. OBJECTIVE: To assess the impact of type 2 diabetes mellitus (DM) on outcome in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS: Academic databases were screened for eligible studies published prior to January 2021. Study quality was assessed using Cochrane's risk of bias tool and the Newcastle Ottawa scale. RESULTS: Pooling studies that met inclusion criteria, we carried out a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% confidence intervals (CIs). A total of ten studies featuring 8,276 participants met eligibility criteria. Type 2 DM patients had significantly higher odds of mortality (pooled OR 1.62; 95% CI 1.10 to 2.37), revascularization (pooled OR 1.41; 95% CI 1.14 to 1.74) and major adverse cardiac events (MACE) (pooled OR 1.39; 95% CI 1.18 to 1.63) relative to non-DM patients following PCI for CTO (regardless of PCI success or failure). Similarly, even when only looking at patients who underwent successful PCI, type 2 DM patients had significantly higher odds of revascularization (pooled OR 1.54; 95% CI 1.20 to 1.97) and MACE (pooled OR 1.35; 95% CI 1.13 to 1.63). CONCLUSION: Type 2 DM significantly impacts the risk for adverse clinical outcomes even after successful PCI for CTO. As such, clinicians need to develop a comprehensive intervention package for DM patients with cardiovascular disease.