Medical therapy vs early revascularization in diabetics with chronic total occlusions:A meta-analysis and systematic review
作者机构：Internal MedicineMercy Saint Vincent Medical CentreToledoOH 43608United States Internal MedicineUniversity of Kansas School of MedicineKansas CityKansas66202United States Department of Cardiovascular FellowshipMercy St Vincent Medical Center and HospitalToledoOH 43608United States Internal MedicineAbington Jefferson HealthAbingtonAbington TownshipMontgomery CountyPA 19001United States Department of Cardiovascular MedicineUniversity of ToledoToledoOH 43606United States Internal MedicineDetroit Medical CenterDetroitMI 48201United States Internal MedicineAbington Jefferson HealthPhiladelphiaPA 19001United States
出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)
年 卷 期：2020年第12卷第11期
页 面：559-570页
学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学]
主 题：Coronary angiography Diabetes mellitus Percutaneous coronary Intervention Coronary bypass grafts Chronic total occlusions Mortality
摘 要：BACKGROUND Management of chronic total occlusions(CTO)in diabetics is challenging,with a recent trend towards early revascularization[ER:Percutaneous coronary intervention(PCI)and bypass grafting]instead of optimal medical therapy(OMT).We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to *** To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with *** Potentially relevant published clinical trials were identified in Medline,Embase,chemical abstracts and Biosis(from start of the databases till date)and pooled hazard ratios(HR)computed using a random effects model,with significant P value*** outcome of interest was all-cause *** outcomes included cardiac death,prompt revascularization(ER)or repeat myocardial infarction(MI).Due to scarcity of data,both Randomized control trials and observational studies were included.4 eligible articles,containing 2248 patients were identified(1252 in OMT and 1196 in ER).Mean follow-up was 45-60 *** OMT was associated with a higher all-cause mortality[HR:1.70,95%confidence interval(CI):0.80-3.26,P=0.11]and cardiac mortality(HR:1.68,95%CI:0.96-2.96,P=0.07).Results were close to *** risk of repeat MI was almost the same in both groups(HR:0.97,95%CI:0.61-1.54,P=0.90).Similarly,patients assigned to OMT had a higher risk of repeat revascularization(HR:1.62,95%CI:1.36-1.94,P0.00001).Sub-group analysis of OMT vs PCI demonstrated higher all-cause(HR:1.98,95%CI:1.36-2.87,P=0.0003)and cardiac mortality(HR:1.87,95%CI:0.96-3.62,P=0.06)in the OMT *** risk of repeat MI was low in the OMT group vs PCI(HR:0.53,95%CI:0.31-0.91,P=0.02).Data on repeat revascularization revealed no difference between the two(HR:1.00,95%CI:0.52-1.93,P=1.00).CONCLUSION In diabetic patients with CTO,there was a trend for improved outcomes with ER regarding all-cause and cardiac death as
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