Abstract Body (Do not enter title and authors here): Background The 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.
Methods We 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 (Figure 1). Multivariable-adjusted and matched logistic regression models were used to assess the primary outcome, which being all-cause in-hospital mortality and secondary outcomes being ischemic stroke, major adverse cardiovascular and cerebrovascular events (MACE and MACCE), and use of mechanical circulatory support (MCS).
Results Among 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 without prediabetes (OR 0.52, 95% CI: 0.31–0.87; p=0.013). However, they demonstrated significantly higher odds of intra-aortic balloon pump (IABP) use (OR 2.20, 95%; p<0.001) and coronary artery bypass grafting (CABG) (OR 2.08, 95% CI: 1.65–2.61; p<0.001), suggesting hemodynamic instability in prediabetes patients. Ischemic stroke rates were higher (OR 1.38, 95% CI: 1.02-1.86; p=0.037). No significant differences were observed in acute kidney injury, dialysis, or mechanical ventilation. MACE were lower in unadjusted (OR 0.76, 95% CI: 0.64-0.89; p=0.001) but was not significant after matching (OR 0.92, 95% CI: 0.72-1.16; p=0.468). (Table 2)
Conclusions Despite 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 early dysglycemic mileu, 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.