ArticleBMC cardiovascular disorders2025
Paradoxical mortality benefit but increased procedural and ischemic risk in prediabetic chronic total occlusion: a national inpatient sample study.
Article in BMC cardiovascular disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe impact of prediabetes on outcomes in chronic total occlusion (CTO) hospitalizations remains unclear. We evaluated the association between prediabetes and in-hospital mortality, complications, and procedural interventions using a nationally representative dataset.
methodsWe queried the National Inpatient Sample (NIS, 2016–2022) to identify adult hospitalizations with a diagnosis of CTO. Patients were stratified by prediabetes status, and 1:1 propensity score matching was performed to balance sociodemographic and comorbid covariates (Fig. 1). Multivariable-adjusted and matched logistic regression models were used to assess the primary outcome, which was all-cause in-hospital mortality, and secondary outcomes were ischemic stroke, major adverse cardiovascular events (MACE), and use of mechanical circulatory support (MCS).
resultsAmong 269,475 CTO hospitalizations, 7,825 (2.9%) had prediabetes (Table 1). After matching (n = 1,494 per group), baseline characteristics were well-balanced. In the matched cohort, prediabetic patients had significantly lower odds of in-hospital mortality compared to those without prediabetes (OR 0.52; 95% CI, 0.31 to 0.87; p = 0.013). However, they demonstrated significantly higher odds of intra-aortic balloon pump (IABP) use (OR 2.20; 95% CI, 1.47 to 3.29; p < 0.001) and coronary artery bypass grafting (CABG) (OR 2.08; 95% CI, 1.65 to 2.61; p < 0.001), suggesting hemodynamic instability in prediabetes patients. Ischemic stroke rates were higher (OR 1.38; 95% CI, 1.02 to 1.86; p = 0.037). No significant differences were observed in acute kidney injury, dialysis, or mechanical ventilation. MACE was lower in unadjusted (OR 0.81; 95% CI, 0.70 to 0.95; p = 0.009) but was not significant after matching (OR 1.01, 95% CI: 0.80 to 1.26; p = 0.955) (Table 2).
conclusionsDespite higher use of advanced interventions and increased ischemic stroke risk, prediabetic patients hospitalized with CTO exhibited lower in-hospital mortality. This paradox demonstrates the complex interplay between pre-diabetic metabolic environment, coronary pathophysiology, and supports the need for better risk stratification. Further prospective studies with longer follow-up durations are warranted to understand the long-term impact of prediabetes in advanced coronary disease.
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