Medical therapy vs early revascularization in diabetics with chronic total occlusions: A meta-analysis and systematic review

Table 1 Baseline characteristics of all studies

Ref.	Damluji et al[12]	Flores-Umanzor et al[13]	Yan et al[15]	Choi et al[14]
Type of study	Randomized control trial (Post Hoc analysis of BARI-2D)	Cohort (prospective)	Cohort (retrospective)	Cohort (retrospective)
Country	United States	Spain	China	South Korea
Period during which study was done	2001-05	2010-14	2007-17	2003-12
Study size (Patients with DM and CTO)	972	538	2361	702
Follow up in months	60	48	45	46
Male (%)	78	82	78	77
Age, mean (yr)	62.5	68.5+/-3.5	60	64.6
Type of stent used if PCI	DES or BMS	-	DES	DES
Exclusion criteria	Need for immediate revascularization, left main coronary disease, a creatinine level > 2.0 mg/dL, a glycated hemoglobin level > 13.0%, heart failure class III or IV, hepatic dysfunction, or previous PCI or CABG within the last 12 mo	No exclusion criteria	(1) Patients who had a history of CABG; (2) Patients who had acute myocardial infarction (MI) due to non-CTO vessels 1 mo before the study; (3) Patients who had left main coronary artery disease; and (4) Patients who had histories of cancer or other diseases that could confuse the end points	History of previous CABG; history of cardiogenic shock or cardiopulmonary resuscitation; ST-segment elevation acute MI during the preceding 48 h
Quality score2	7	5	5	5

¹Propensity Matched Population.

²Criteria used for scoring: Proper Randomization (Score: 1 point), similarity of treatment groups in relevant variables at baseline (1 point), blinding of subjects and investigators (1 point for each), specified eligibility criteria (1 point), valid point estimates and measures of variability (1 point) and data on degree of compliance (1 point). More details in text. DM: Diabetes mellitus; CTO: Chronic total occlusion; PCI: Percutaneous coronary intervention; RCT: Randomized control trial; DES: Drug eluting stent; BMS: Bare metal stent; CABG: Coronary artery bypass grafting.

Table 2 Percentage prevalence of co-morbidities across studies (actual prevalence in brackets)

Ref.	Damluji et al[12]		1Flores-Umanzor et al[13]			Yan et al[15]		Choi et al[14]
	OMT (n = 490)	ER (n = 482)	OMT (n = 326)	ER	ER	OMT (n = 118)	ER (n = 118)	OMT (n = 318)	ER (n = 384)
				PCI (n = 76)	CABG (n = 136)
HTN	80 (385)	81 (387)	85 (276)	82 ( 62)	86 (117)	66.9 (79)	71.2 (84)	70.7 (225)	70.3 (270)
Previous MI	44 (214)	41 (197)	33 (108)	28 (21)	28 (21)	56.8 (67)	55.9 (66)	34.9 (111)	18.0 (69)
Prior CHF	7 (36)	9 (43)	-	-	-	14.4 (17)	10.2 (12)	-	-
Prior Stent/PCI	11 (56)	12 (59)	-	-	-	48.3 (57)	42.4 (50)	30.5 (97)	22.1 (85)
Prior CVA/TIA	10 (49)	10 (46)	-	-	-	5.1 (6)	5.9 (7)	12.3 (39)	11.2 (43)
Prior Revascularizatio	31 (151)	26 (124)	-	-	-	-	-	-	-
Prevnious CABG	-	-	14 (45)	5 (4)	4 (5)	-	-	0	0
HbA1c mean	7.4	7.3	7.6 ± 0.1	7.6 ± 0.2	7.3 ± 0.1	-	-	-	-
Dyslipidemia	83 (402)	84 (400)	75 (246)	71 (54)	74 (100)	51.7 (61)	50 (59)	21.7 (69)	31.3 (120)
Smoking	-	-	52 (169)	55 (42)	59 (80)	55.9 (66)	57.6 (68)	28.6 (91)	32.8 (126)
Peripheral vascular disease	-	-	45 (145)	33 (25)	35 (47)	3.4 (4)	3.4 (4)	6.0 (19)	3.4 (13)

¹Data given separately for percutaneous coronary intervention and Coronary Artery Bypass Grafting group. OMT: Optimal medical therapy; ER: Early revascularization; N: Number of subjects; PCI: Percutaneous coronary intervention; CABG: Coronary Artery Bypass Grafting; HTN: Hypertension; MI: Myocardial infarction; CHF: Heart failure; CVA: Cerebrovascular accident, HbA1c: Hemoglobin A1c.

Table 3 Chronic total occlusions location with number of chronic total occlusions lesions among studies in percentages (actual prevalence in brackets)

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Ref.	Damluji et al[12]		Flores-Umanzor et al[13]		Yan et al[15]		Choi et al[14]
	OMT	ER	OMT (n = 326)	ER (n = 212)	OMT (n = 118)	ER (n = 118)	OMT (n = 318)	ER (n = 384)
Number of CTO lesions
1	-	-	80 (261)	75 (159)			-	-
2	-	-	79 (60)	24 (50)			-	-
3	-	-	1.5 (5)	1.4 (3)			-	-
CTO location
LAD artery	-	-	18 (60)	24 (51)	30.5 (36)	28.0 (33)	26.4 (84)	38.5 (148)
LCX artery	-	-	19 (62)	20 (42)	28.0 (33)	26.3 (31)	36.5 (116)	29.2 (112)
RCA	-	-	52 (170)	47 (100)	41.5 (49)	45.8 (54)	56.3 (117)	47.9 (184)
Other coronary artery branches	-	-	10 (34)	9 (19)	-	-	-	-

LAD: Left anterior descending; LCX: Left circumflex; RCA: Right coronary artery; OMT: Optimal medical therapy; ER: Early revascularization; N: number of subjects.