Non-infarct related chronically occluded coronary arteries and its association with diabetes and prediabetes

Abstract

Background: Chronic coronary total occlusions (CTOs) are mostly associated with infarct-related artery (IRA CTO); however, all CTOs may not always lead to or be caused by STEMI. Clinical profile of patients with non-infarct-related artery related CTOs (non-IRA CTO) might give us endogenous cardioprotective mechanisms activated in response to myocardial ischemia caused by atherosclerotic process. Objective: We aimed to evaluate the clinical profile of non-IRA CTO with regard to cardiovascular risk factors. Methods: We reviewed our invasive cardiology database searching for the non-IRA CTO of any major coronary arteries, and assessed whether or not they have the clinical history or electrocardiographic (Q waves, loss of R wave), echocardiographic or left ventriculographic (segmental wall motion abnormality) evidence of previous myocardial infarction. The rates of non-IRA CTO were compared among diabetes, prediabetes and non-diabetic/prediabetic control groups. Results: This was a cross-sectional study of 2180 patients who underwent coronary angiogram for the evaluation of stable coronary artery disease at a tertiary care hospital from January 2018 to April 2018. We detected 41 consecutive patients with non-IRA CTO (1.9%) with a low prevalence of smoking (7%). The most of patients (93%) had either DM (61%) or prediabetes (32%), and this was statistically different from non-diabetic/prediabetic patients (p ≤ 0.001). Conclusion: Non-IRA CTOs have been found to be associated with prediabetes and diabetes. Whereas the DM and prediabetes aggressively induces atherosclerosis, they can also activate some endogenous cardio-protective mechanisms protecting the left ventricular contractile function.