Diabetes with chronic total arterial occlusion carries a poor prognosis. Little is known about patients with diabetes and stable left circumflex artery (LCX) chronic total occlusion (LCX-CTO). We aimed to determine whether stable LCX-CTO should be recanalized in patients with diabetes. We analyzed patients with LCX-CTO, diabetes, and stable clinical symptoms (i.e., silent ischemia or symptomatic stable angina), who underwent successful revascularization (SR) or medical therapy (MT). The primary endpoint was major adverse cardiac events. Propensity score-matched analyses and Cox regression were performed. The proximal LCX-CTO subpopulation was analyzed. A stratified subgroup analysis was conducted for the primary endpoint. We enrolled 620 patients, stratified into MT (448, 72.26%) and SR groups (172, 27.74%). After a median 44-month follow-up, univariate and multivariable models showed that SR offered no clinical benefits regarding major adverse cardiac events (adjusted hazard ratio [aHR]: 0.860, 95% confidence interval [CI]: 0.520-1.423, P = .558). This was consistent for other clinical endpoints as well. However, in the subpopulation with proximal LCX-CTO, SR was superior in terms of cardiac (aHR: 0.284, 95% CI: 0.082-0.984) and all-cause mortality (aHR: 0.455, 95% CI: 0.167-1.239). Revascularization should be attempted in patients with diabetes who have proximal LCX-CTO.
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