Glycemic Control Status and Long-term Clinical Outcomes in Diabetic Chronic total occlusion patients: An Observational Study

Abstract Background: Whether good glycemic control can result in clinical benefits for diabetic chronic total occlusion (CTO) patients are limited and controversial.Methods: We assigned the enrolled patients into 2 groups based on one-year glycosylated hemoglobin A (HbA1c) levels: HbA1c<7% group (n=448) and HbA1c≥7% group (n=581). We further subdivided the patients into the successful CTO revascularization (CTO-SR) and non-successful CTO revascularization (CTO-NSR) groups. Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiovascular events (MACE) and other endpoints.ResultsThere were no significant differences between the groups in terms of the most endpoints in the overall patients. After propensity score-matched analysis, patients with HbA1c < 7.0 tended to be superior in terms of MACE, which was mainly attributed to repeat revascularization but the other endpoints. What’s more, the benefit of the HbA1c <7 group was more prominent among patients with CTO-NSR in terms of MACE, repeat revascularization and target vessel revascularization (TVR). And, the improvement of the HbAc1＜7 group was more prominent among patients without chronic heart failure (CHF) (P=0.027). Conclusions: HbA1c <7.0 was associated with a reduced incidence of MACE, which was mainly attributed to a reduction in repeat revascularization. Well glycemic control can improve diabetic CTO patients’ clinical prognosis, especially in CTO-NSR patients.Trial registration: The present study was approved by the Clinical Research Ethics Committee of Beijing Anzhen Hospital, Capital Medical University (No:2018008X). Informed consent was exempt by the committee.