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Objective: Until then, there was only a few data of re-canalization for chronic total occlusion (CTO) on viable myocardium and heart function in the clinical compared trial between patients with or without diabetes mellitus. The purpose of this study was to compare the effect of re-canalization for CTO lesion on the viable myocardium and cardiac performance as well occurrence of the major adverse cardiac event (MACE) in patients with or without diabetic mellitus by 99mTc-MIBI single photon emission computed tomography (SPECT) and ultrasonic cardiogram (UCG).Methods:78 patients (57 male and 21 female, average age was 62.34±7.1 years old) with chronic total occlusion were enrolled. Depending on whether the patients with diabetes mellitus(>1 year), the patients were divided into DM group(n=35) and NDM group(n=43). Inclusion criteria included both complete occlusions(Thrombolysis In Myocardial Infarction [TIMI] flow grade 0), where no anterograde filling beyond the lesion was visible, and functional occlusions(TIMI flow grade 1), where a faint, late anterograde flow with incomplete opacification of the distal vessel in the absence of a discernible lumen channel. Patients with angina or inducible ischemia by SPECT, ETT, Holter were selected for the study. The diameter of the coronary artery lumen must >2.5mm and the estimated duration of occlusion must > 1 month,all patients were first undergone succeseful PCI. Patients were excluded for the following reasons: 1. patients with acute myocardial infarction within 1 month; 2.cerebrovascular accident within 6 month; 3.severe valvular heart disease, dilated cardiomyopathy and hypertrophic cardiomyopathy; 4.cardiac shock 5.chronic renal or hepatic failure 6.contraindication to aspirin ,clopidogrel or heparin. In each group, detailed clinical information of patients including risk factors were collected. All patients accepted succesful PCI,and the results of CAG were analyzed using the quantitative coronary analysis(QCA) to evaluate the condition of coronary artery,the results of the two groups were compared. All the patients underwent 99mTc-MIBI SPECT and UCG in 1st week and 6th month after the PCI to evaluate the viable myocardial and heart function . All the viable myocardial and heart function parameters of the 2 groups were also compared. During the 6 months, the MACE, including cardiac death, angina, myocardial infarction and coronary artery bypass graft, was calculated to assess the prognosis of the 2 groups. All the data were analysed by SAS 6.12 statistics software, P value<0.05 was considered to have statistical significance.Results: Except the collateral circulation of 1 class and 2 class has significant diffeernces(14.29% vs. 23.26%,34.29% vs.16.28%,P<0.05),there were no significant differences of the baseline data between the two groups.The other characteristics of coronary angiography were similar in the 2 groups. The baseline data of SPECT and UCG were no distinct difference between DM group and NDM group. In the two groups LVEDVI、LVESVI were decreased at 6th month than those at 1st week(79.54±39.49vs.65.27±15.31, 37.42±35.34vs.27.75±13.75,81.48±30.54 vs. 67.61±28.58,42.74±22.81 vs. 30.12±11.85,P<0.05 ) ,and LVEF was significant increased(53.57±13.5%vs.58.42±9.75%, 50.32±11.3%vs.61.80±10.4%,P<0.01=.In the DM group, the defect size significantly reduced (230.51±46. 4vs.176.54±2.7,P<0 .01)and percentage ofredionuclide scintigraphic count significantly increasd(23.74±7.4% vs. 28.51±8.3%, P<0.05)between rest and nitroglycerin interventional 99mTc-MIBI tomography,and the same result were shown in the NDM group, (240.46±49.41vs.201.43±35.9 P<0.01 , 26.42±8.0%vs.31.64±8.1%, P<0.05).Between the two groups ,defect size of rest and nitroglycerin interventional ( 230.51±46.4vs.240.46, P>0.05,176.54±2.7vs.201.43±35.9, P>0.05)was simmilar ,and the percentage of redionuclide scintigraphic count significantly were also no significant difference bewteew the two groups(23.74±7.4%vs.26.42±8.0%, 28.51±8.3%vs.31.64±8.1%, P>0.05).After 6 months, the two groups repeated nitroglycerin interventional99mTc-MIBI tomography and when compared with 1week, defect size significantly reduced(176.54±2.7vs.143.75±30.8, P<0.01),(201.43±35.9vs.159.52±34.0, P<0.01);and the percentage of redionuclide scintigraphic count significantly increased(28.51±8.3)%vs.(33.75±9.4)%,P<0.05,(31.64±8.1)%vs.(36.76±9.0)%, P<0.05.During the following up 6 months ,the rate of MACE(14.26%vs.10.60%,P>0.05)beween the two groups were similar. In the DM group one patient died of heart failure(2.86%),and one patient undergone CABG(2.86%); in the NDM group two patients died of heart failure (4.65%) , no statistical significance. Other MACE (angina, reoccurred MI) was similar. Considering all of the events, the prognosis of the two groups were no difference.Conclusion:The re-canalization for CTO in patients with and without DM might have a similar benefit on viable myocardium and heart funtion as well as prevention from MACE.
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