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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve showing time until myocardial infarction &#40;mean follow-up of 18 months&#41; in chronic total occlusion patients undergoing percutaneous coronary intervention&#44; compared by diabetes status&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary chronic total occlusions &#40;CTOs&#41; are found in 15&#8211;25&#37; of patients with symptoms of angina or with coronary artery disease &#40;CAD&#41; undergoing a coronary angiogram &#40;CA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Data from retrospective studies and evidence from small randomized controlled trials &#40;RCTs&#41; show that successful recanalization of CTOs by percutaneous coronary intervention &#40;PCI&#41; is associated with improvements not only in quality of life&#44; but also in angina&#44; heart failure &#40;HF&#41; symptoms and left ventricular ejection fraction &#40;LVEF&#41;&#44; although with no statistically significant impact on survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nevertheless&#44; CTO recanalization constitutes less than 5&#37; of PCI procedures in contemporary practice&#44; except in tertiary centers&#59; this may be due to its greater procedural complexity&#44; the risk of complications&#44; and lower success rates in centers with non-specialized teams&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with diabetes have more extensive and complex CAD compared with those without&#44; including higher rates of multivessel disease and CTO vessels&#44; with previous studies showing an incidence of 30&#8211;40&#37; of CTO lesions in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;6</span></a> Although common&#44; CTO PCI is performed less frequently in diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with diabetes and incomplete revascularization have an increased long-term risk of cardiovascular events&#44; and CTO lesions have been shown to be a strong independent predictor of incomplete revascularization in patients undergoing PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> Recent studies suggest similar technical success rates of CTO PCI in diabetic and non-diabetic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Research has also shown the benefits of CTO PCI in diabetic patients&#44; mainly in symptom relief and improved quality of life&#44; but conflicting results and a lack of well-designed RCTs contribute to some controversy involving the treatment of CTO lesions in these groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;4&#44;5&#44;8&#44;12&#44;14</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study aimed to analyze the impact on clinical outcomes and symptom recurrence in type 2 diabetes mellitus &#40;T2DM&#41; patients undergoing CTO PCI&#46; Additionally&#44; we aimed to identify independent predictors of symptom recurrence and clinical outcomes in this group&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A single-center&#44; retrospective cohort analysis with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Recruitment and selection</span><p id="par0045" class="elsevierStylePara elsevierViewall">Eligibility criteria included age &#8805;18 years and a personal history of symptoms suggestive of ischemic heart disease in which a significant atherosclerotic vessel lesion was identified on CA and classified as a CTO &#40;coronary lesion with thrombolysis in myocardial infarction &#91;TIMI&#93; anterograde flow score of 0 with chronic characteristics thought to have been present for at least three months&#41;&#46; Patients who only underwent a diagnostic study&#44; even if they had a CTO vessel&#44; or had an unsuccessful procedure were excluded from the study&#46; A previously published hybrid algorithm for CTO PCI was used for revascularization&#44; and patients were divided into two groups according to their diabetes status &#40;T2DM and non-T2DM&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> T2DM was presumed in patients with a known previous diagnosis of T2DM or with a recorded inpatient random glycated hemoglobin &#8805;6&#46;5&#37;&#46; LVEF was estimated by the modified Simpson&#39;s biplane method&#46; Obesity was defined as a body mass index &#8805;30 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; and chronic renal failure as creatinine clearance of &#60;60 ml&#47;m<span class="elsevierStyleSup">2</span> &#40;Cockcroft&#8211;Gault formula&#41;&#46; Symptoms were assessed through medical records&#59; no scales or questionnaires were applied and no patients were contacted by telephone&#46; The use of at least one antianginal drug&#44; an angiotensin-converting enzyme inhibitor&#47;angiotensin receptor blocker&#47;angiotensin receptor-neprilysin inhibitor&#44; 100 mg aspirin &#40;or anticoagulation in atrial fibrillation&#41;&#44; dual antiplatelet therapy or dual antithrombotic therapy for at least six months&#44; and a lipid-lowering drug &#40;statin and&#47;or ezetimibe&#41; were defined as optimal medical therapy &#40;OMT&#41;&#46; Periprocedural myocardial infarction &#40;MI&#41; was assessed and defined as type 4a in accordance with the fourth universal definition of MI&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Atherosclerotic disease progression was defined as progression of atherosclerosis in the index vessel and&#47;or in non-CTO vessels&#46; Baseline patient demographic data&#44; cardiovascular risk factors&#44; and clinical&#44; laboratory&#44; echocardiographic and angiographic data were also recorded&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study abides by the ethical requirements stated in the 1975 Helsinki Declaration and received ethical approval by the local hospital ethics committee&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcomes</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study&#39;s primary outcome was recurrence of angina and&#47;or HF symptoms &#40;total symptom recurrence&#41; in a two-year follow-up&#46; HF symptoms were defined as dyspnea and&#47;or fatigue associated with an underlying heart condition&#46; Secondary outcomes were defined as MI and all-cause mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Categorical variables were presented as frequencies and percentages&#44; and continuous variables as means and standard deviation&#44; or medians and interquartile range for variables with skewed distribution or a significant Shapiro&#8211;Wilk test&#46; Comparisons between groups were performed using the chi-square test&#44; Student&#39;s t test or Mann&#8211;Whitney test&#44; as appropriate&#46; Multivariate analysis was performed using logistic and Cox regression to identify predictors associated with the outcomes&#46; A p-value &#60;0&#46;05 was taken to indicate statistical significance&#46; The statistical analysis was performed using IBM SPSS Statistics&#44; version 21&#46;0 &#40;IBM SPSS&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Baseline patient demographics and medical history</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 191 patients were recruited&#44; with 14 being excluded &#40;12 had an unsuccessful procedure and two only underwent CA&#41;&#46; All available characteristics for the final sample of 177 patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The groups were composed of 70 &#40;39&#46;5&#37;&#41; patients with T2DM and 107 &#40;60&#46;5&#37;&#41; without T2DM&#46; The overall sample had a mean age of 64&#46;5&#177;11&#46;4 years and 82&#46;5&#37; were male&#46; Medical history included hypertension in 74&#46;6&#37; of patients&#44; dyslipidemia in 72&#46;9&#37;&#44; obesity in 18&#46;2&#37; and HF in 15&#46;3&#37;&#46; T2DM patients were older&#44; with a mean age of 67&#46;9&#177;10&#46;1 &#40;p&#61;0&#46;010&#41;&#44; and more likely to have chronic renal failure &#40;14&#46;3&#37;&#44; p&#61;0&#46;011&#41;&#46; Most patients were on OMT &#40;83&#46;1&#37;&#44; p&#61;0&#46;382&#41; and antianginal drugs &#40;98&#46;3&#37;&#44; p&#61;0&#46;824&#41;&#44; with no difference regarding diabetes status&#46; Insulin replacement therapy was prescribed in 25 &#40;35&#46;7&#37;&#41; diabetic patients&#44; and mean glycated hemoglobin was 8&#46;2&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Angiographic characteristics of chronic total occlusion patients undergoing percutaneous coronary intervention</span><p id="par0070" class="elsevierStylePara elsevierViewall">The right coronary artery &#40;RCA&#41; was the most frequently occluded artery&#44; and an anterograde approach was most frequently employed&#46; Multivessel disease was present in 85&#46;9&#37; of patients&#46; T2DM patients presented with lower creatinine clearance levels &#40;69&#46;3&#177;27&#46;9 ml&#47;min&#44; p&#61;0&#46;006&#41;&#44; and contrast doses were therefore lower during PCI in these patients &#40;225&#177;84&#46;8 ml&#44; p&#61;0&#46;009&#41;&#46; Ischemia or myocardial viability testing was performed in 43 &#40;24&#46;3&#37;&#44; p&#61;0&#46;718&#41; patients&#44; most frequently stress echocardiography &#40;10&#46;7&#37;&#44; p&#61;0&#46;212&#41;&#46; Periprocedural MI occurred in 10 &#40;5&#46;6&#37;&#44; p&#61;0&#46;976&#41; patients during CTO PCI&#46; The rate of periprocedural complications was 5&#46;1&#37;&#44; mainly vessel perforation &#40;2&#46;26&#37;&#41;&#44; but no differences were found between groups&#46; Although LVEF was mildly reduced at baseline&#44; ventricular function improved in both groups after intervention in a mean follow-up of 18 months &#40;p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Outcomes</span><p id="par0075" class="elsevierStylePara elsevierViewall">The primary outcome &#40;total symptom recurrence&#41; occurred in 16&#46;6&#37; of patients&#44; with no difference between groups &#40;non-T2DM 13&#46;6&#37; vs&#46; T2DM 21&#46;2&#37;&#44; p&#61;0&#46;194&#41; in two-year follow-up &#40;mean follow-up of 18 months&#41;&#46; Angina recurrence was significant higher in the T2DM group &#40;15&#46;2&#37;&#44; p&#61;0&#46;043&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Of the total population&#44; 11 &#40;6&#46;2&#37;&#41; had CTO restenosis and 22 &#40;12&#46;4&#37;&#41; had atherosclerotic disease progression&#44; mainly in the diabetic population &#40;p&#61;0&#46;030 and p&#60;0&#46;001&#44; respectively&#41;&#46; In patients with symptom recurrence &#40;total or isolated angina&#41;&#44; there was no difference in the restenosis rate according to diabetic status &#40;p&#61;0&#46;190 and p&#61;0&#46;790&#44; respectively&#41;&#46; Nevertheless&#44; atherosclerotic disease progression was more frequent in diabetic patients with total symptom or angina recurrence &#40;p&#61;0&#46;008 and p&#61;0&#46;013&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">MI and all-cause mortality showed no differences between groups &#40;T2DM 1&#46;5&#37;&#44; p&#61;0&#46;786 and 4&#46;5&#37;&#44; p&#61;0&#46;352&#44; respectively&#44; on survival analysis&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Independent predictors for primary and secondary outcomes</span><p id="par0090" class="elsevierStylePara elsevierViewall">The presence of T2DM and LVEF was not independent predictors of the primary outcome &#40;p&#61;0&#46;429&#44; hazard ratio &#91;HR&#93; 1&#46;37&#44; 95&#37; confidence interval &#91;CI&#93; 0&#46;62&#8211;2&#46;98 and p&#61;0&#46;737&#44; HR 0&#46;994&#44; 95&#37; CI 0&#46;95&#8211;1&#46;03&#44; respectively&#41;&#46; RCA as the CTO vessel was an independent predictor for total symptom recurrence after PCI &#40;p&#61;0&#46;019&#44; HR 2&#46;68&#44; 95&#37; CI 1&#46;17&#8211;6&#46;14&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Independent predictors of all-cause mortality were LVEF and creatine clearance &#40;p&#61;0&#46;039&#44; HR 0&#46;92&#44; 95&#37; CI 0&#46;85&#8211;0&#46;99 and p&#61;0&#46;013&#44; HR 0&#46;96&#44; 95&#37; CI 0&#46;93&#8211;0&#46;99&#44; respectively&#41;&#46; The presence of T2DM was not an independent predictor of all-cause mortality &#40;p&#61;0&#46;975&#44; HR 1&#46;03&#44; 95&#37; CI 0&#46;16&#8211;6&#46;34&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study found that recanalization of CTO lesions by PCI and its benefit in terms of clinical outcomes and symptom recurrence were independent of T2DM status&#46; However&#44; recurrence of angina was more common in diabetics&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The sample included 40&#37; of patients with T2DM&#44; with a mean age of 65 years and mainly male&#44; of whom almost three quarters had a medical history of hypertension and dyslipidemia&#44; and a mean LVEF of 47&#37; was observed&#46; Sample characteristics were similar to those in other recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;8&#44;12&#44;13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Focusing on the procedure itself&#44; Salisbury et al&#46; reported that 60&#37; of CTOs affected the RCA and an anterograde approach was adopted in 38&#8211;42&#37; of cases&#46; In the present study&#44; the RCA was also the most commonly affected artery &#40;45&#37;&#41;&#44; while an anterograde approach was employed more often than in Salisbury et al&#46;&#8217;s study &#40;89&#37;&#41;&#46; The rate of periprocedural complications was low&#44; mainly vessel perforation &#40;2&#37;&#41;&#44; and lower than described by Salisbury et al&#46; &#40;who reported perforation in 8&#8211;9&#37; of cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Symptom recurrence after a two-year follow-up was low &#40;16&#46;6&#37;&#41;&#44; with no difference found between groups&#46; In addition&#44; T2DM was not an independent predictor of symptom recurrence&#46; Similarly&#44; Salisbury et al&#46; and Zhao et al&#46; reported angina improvement of almost 20 points on the Seattle Angina Questionnaire angina frequency score and dyspnea relief during the first year after recanalization&#44; independently of diabetes status&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;12</span></a> Notwithstanding&#44; in the present analysis&#44; recurrence of isolated angina was more frequent in T2DM patients &#40;15&#37;&#44; p&#61;0&#46;043&#41;&#46; This could be related to poorer disease control &#40;mean glycated hemoglobin was 8&#46;2&#37;&#41;&#44; which affects atherosclerotic disease progression&#46; Even in patients with relatively controlled disease&#44; there is evidence that progression of CAD is difficult to stop&#44; with higher rates of angina recurrence after PCI&#46; Although rates of stent restenosis and atherosclerotic disease progression were higher in the diabetic population&#44; as expected&#44; in patients with total symptom or isolated angina recurrence there was no significant difference in stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Most patients were on OMT and taking antianginal drugs&#44; regardless of diabetic status&#44; which probably contributed to the low rate of symptom recurrence reported&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Revascularization of RCA CTO and creatine clearance were independent predictors of total symptom recurrence and all-cause mortality&#44; respectively&#46; Patients with T2DM showed higher rates of RCA CTO &#40;although this was not statistically significant&#41; and significantly lower levels of creatine clearance&#44; which may have affected outcomes&#44; particularly angina recurrence&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We reported an improvement in LVEF from baseline to post-procedure assessment&#44; from mildly reduced to preserved in both groups without statistical difference&#44; which could have influenced the lower rates of HF symptoms reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">To date&#44; only two studies have reported that successful CTO PCI relieved symptoms of angina and dyspnea regardless of diabetes diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;12</span></a> Our study corroborates these results&#44; and further highlights that successful CTO PCI could represent an effective strategy regardless of T2DM status&#46; Further studies are needed to compare the outcomes of CTO PCI in T2DM patients&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Limitations</span><p id="par0140" class="elsevierStylePara elsevierViewall">Some limitations should be acknowledged&#46; This was an observational study&#44; therefore the data collected are limited to medical records&#46; Patient symptoms were not assessed by scales or questionnaires&#44; which could increase ambiguity&#46; Our study included only successful CTO PCI&#59; failed CTO PCI was not addressed&#44; which may limit the validity of the conclusions&#46; Finally&#44; the data in our study are from only one CTO PCI center&#44; so our conclusions may not be generalizable to other cardiac centers&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">The presence of T2DM did not influence total symptom recurrence or clinical outcomes in CTO patients undergoing revascularization by PCI in a two-year follow-up&#44; despite a markedly higher recurrence of angina in this group&#46; These results support the premise that diabetes should not be an impediment when opting for CTO PCI&#44; which in fact may be an effective strategy in preventing symptom recurrence in this group&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Angiographic characteristics of chronic total occlusion patients undergoing percutaneous coronary intervention"
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            0 => "Chronic total occlusions"
            1 => "Type 2 diabetes"
            2 => "Symptom recurrence"
            3 => "Clinical outcomes"
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          "palabras" => array:4 [
            0 => "Oclus&#245;es totais cr&#243;nicas"
            1 => "Diabetes tipo 2"
            2 => "Recorr&#234;ncia de sintomas"
            3 => "<span class="elsevierStyleItalic">Outcomes</span> cl&#237;nicos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary chronic total occlusions &#40;CTOs&#41; are relatively common findings in patients with type 2 diabetes mellitus &#40;T2DM&#41;&#46; However&#44; the indication for percutaneous coronary intervention &#40;PCI&#41; and its clinical benefit in these patients remain controversial&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020&#46; Patients were divided into two groups according to previous T2DM diagnosis &#40;T2DM and non-T2DM&#41;&#46; The primary outcome was recurrence of angina and&#47;or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 177 patients &#40;82&#46;5&#37; male&#41; were included in the analysis&#44; with a mean age of 65&#177;11 years&#46; The primary outcome &#40;total symptom recurrence&#41; occurred in 16&#46;6&#37; of the sample&#44; with no difference between groups &#40;non-T2DM 13&#46;6&#37; vs&#46; T2DM 21&#46;2&#37;&#44; p&#61;0&#46;194&#41; in a two-year follow-up&#46; Angina recurrence was significantly more frequent in T2DM patients &#40;15&#46;2&#37;&#44; p&#61;0&#46;043&#41;&#46; The presence of T2DM was not an independent predictor of symptom recurrence &#40;p&#61;0&#46;429&#44; HR 1&#46;37&#44; 95&#37; CI 0&#46;62&#8211;2&#46;98&#41;&#46; Myocardial infarction and all-cause mortality were also not different between groups &#40;T2DM 1&#46;5&#37;&#44; p&#61;0&#46;786 and 4&#46;5&#37;&#44; p&#61;0&#46;352&#44; respectively&#44; on survival analysis&#41;&#46; Independent predictors of all-cause mortality were left ventricular function and creatine clearance &#40;p&#61;0&#46;039&#44; HR 0&#46;92&#44; 95&#37; CI 0&#46;85&#8211;0&#46;99 and p&#61;0&#46;013&#44; HR 0&#46;96&#44; 95&#37; CI 0&#46;93&#8211;0&#46;99&#44; respectively&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">T2DM did not influence outcomes in CTO patients undergoing PCI&#44; and its presence should not be a limiting factor in deciding on CTO revascularization&#46;</p></span>"
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            "titulo" => "Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As oclus&#245;es totais cr&#243;nicas &#40;CTO&#41; s&#227;o achados comuns em doentes com diabetes tipo 2 &#40;DM2&#41;&#46; A indica&#231;&#227;o para revasculariza&#231;&#227;o percut&#226;nea &#40;PCI&#41; e o seu benef&#237;cio cl&#237;nico permanecem controversos&#46; Este estudo foi desenhado para tentar responder a esta quest&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo de coorte retrospetivo com colheita de dados prospetiva&#44; realizada em doentes com CTO submetidos a PCI entre 2019-2020&#46; Formados dois grupos &#40;DM2 e n&#227;o-DM2&#41;&#46; O <span class="elsevierStyleItalic">outcome</span> prim&#225;rio foi definido como a recorr&#234;ncia de sintomas de angor e&#47;ou insufici&#234;ncia card&#237;aca e os <span class="elsevierStyleItalic">outcomes</span> secund&#225;rios a ocorr&#234;ncia de enfarte do mioc&#225;rdio e mortalidade por todas as causas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise com 177 doentes&#44; idade m&#233;dia de 65&#177;11 anos e 82&#44;5&#37; do sexo masculino&#46; O <span class="elsevierStyleItalic">outcome</span> prim&#225;rio ocorreu em 16&#44;6&#37; dos doentes&#44; sem diferen&#231;a entre os grupos &#40;n&#227;o-DM2 13&#44;6&#37; <span class="elsevierStyleItalic">versus</span> DM2 21&#44;2&#37;&#44; p&#61;0&#44;194&#41; em dois anos&#46; A recorr&#234;ncia de angor foi significativamente maior nos doentes com DM2 &#40;15&#44;2&#37;&#44; p&#61;0&#44;043&#41;&#46; A DM2 n&#227;o foi um preditor independente do <span class="elsevierStyleItalic">outcome</span> prim&#225;rio &#40;p&#61;0&#44;429&#44; HR 1&#44;37&#44; 95&#37; CI 0&#44;62 a 2&#44;98&#41;&#46; A ocorr&#234;ncia de enfarte e mortalidade n&#227;o mostrou diferen&#231;as entre os grupos &#40;DM2 1&#44;5&#37;&#44; p&#61;0&#44;786 e 4&#44;5&#37;&#44; p&#61;0&#44;352&#44; respetivamente &#8211; an&#225;lise de sobreviv&#234;ncia&#41;&#46; A fun&#231;&#227;o ventricular esquerda e a <span class="elsevierStyleItalic">clearance</span> de creatinina foram preditores independentes de mortalidade &#40;p&#61;0&#44;039&#44; HR 0&#44;92&#44; 95&#37; CI 0&#44;85 a 0&#44;99 e p&#61;0&#44;013&#44; HR 0&#44;96&#44; 95&#37; CI 0&#44;93 a 0&#44;99&#44; respetivamente&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A DM2 n&#227;o influenciou os <span class="elsevierStyleItalic">outcomes</span> nos doentes com CTO submetidos a PCI&#44; sendo que a sua presen&#231;a n&#227;o dever&#225; ser um fator limitativo na decis&#227;o de revasculariza&#231;&#227;o&#46;</p></span>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ACS&#58; acute coronary syndrome&#59; CCS&#58; Canadian Cardiovascular Society&#59; DAPT&#58; dual antiplatelet therapy&#59; DAT&#58; dual antithrombotic therapy&#59; HF&#58; heart failure&#59; OAC&#58; oral anticoagulant therapy&#59; OMT&#58; optimal medical therapy&#59; PCI&#58; percutaneous coronary intervention&#59; SD&#58; standard deviation&#59; T2DM&#58; type 2 diabetes mellitus&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&#40;n&#61;177&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gender&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93&#46;0 &#40;86&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">53&#46;0 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">146 &#40;82&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&#46;0 &#40;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;055&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#46;4&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#46;9&#177;10&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#46;5&#177;11&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hypertension&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">77&#46;0 &#40;72&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">132 &#40;74&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dyslipidemia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#46;0 &#40;72&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">129 &#40;72&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;734&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Obesity&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">History of HF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Previous stroke&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Atrial fibrillation&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Chronic renal disease&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ischemic heart disease&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Chronic lung disease&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76&#46;0 &#40;42&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CTO vessel</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LCA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LAD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LCx&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#46;0 &#40;29&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#46;0 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RCA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">47&#46;0 &#40;43&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79&#46;0 &#40;44&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multivessel disease&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">90 &#40;84&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62 &#40;88&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">152 &#40;85&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Approach&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antegrade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93&#46;0 &#40;86&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#46;0 &#40;91&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;88&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retrograde&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;00 &#40;8&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;354&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">J-CTO score&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;74&#177;0&#46;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;81&#177;0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;79&#177;0&#46;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Radiation dose</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Air kerma&#44; mGy&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1840 &#40;2030&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1932 &#40;1804&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2043 &#40;1784&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kerma area product&#44; Gy<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;113&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">104 &#40;124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">120 &#40;113&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;810&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ischemia&#47;viability test&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">27&#46;0 &#40;25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;0 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;0 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;718&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stress echocardiography&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;00 &#40;7&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;0 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SPECT-MPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;00 &#40;2&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;00 &#40;4&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;00 &#40;3&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0 &#40;9&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;00 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;0 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;654&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF at baseline&#44; &#37;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&#177;10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;2&#177;10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF after PCI&#44; &#37;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;6&#177;9&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;2&#177;9&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;2&#177;9&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Creatinine clearance&#44; ml&#47;min&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;6&#177;24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;3&#177;27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;1&#177;26&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PCI time&#44; min&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#177;56&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&#177;65&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&#177;56&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Contrast volume&#44; ml&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">270&#177;96&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&#177;84&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">254&#177;94&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Periprocedural complications&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;00 &#40;3&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;00 &#40;7&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;00 &#40;5&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dissection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;00 &#40;1&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;1&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00 &#40;1&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perfuration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;00 &#40;1&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;00 &#40;2&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;00 &#40;2&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00 &#40;0&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;1&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;0&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stroke&#47;MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Periprocedural MI&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;976&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;194&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;043&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;0 &#40;9&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#46;00 &#40;1&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;838&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>All-cause mortality&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;576&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">29&#46;0 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#46;00 &#40;1&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;00 &#40;5&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;0 &#40;6&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disease progression&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;00 &#40;3&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#46;0 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&#46;0 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;n&#61;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CTO restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;00 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;00 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;00 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;190&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disease progression&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;00 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#46;0 &#40;78&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#46;0 &#40;53&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Angina recurrence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CTO restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;00 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;00 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;00 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;790&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Disease progression&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;00 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;0 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#46;0 &#40;81&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Patients who underwent coronary angiography during follow-up&#44; compared by diabetes status and symptom recurrence&#46;</p>"
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Original Article
Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus
Outcomes clínicos da intervenção coronária percutânea nas oclusões crónicas totais em doentes com diabetes mellitus tipo 2
Hugo Costaa,
Autor para correspondência
hugoalexcosta@sapo.pt

Corresponding author.
, Miguel Espírito-Santoa, João Bispoa, João Guedesa, Jorge Mimosoa, Hugo Palmeiroa, Rui Baptista Gonçalvesb, Hugo Vinhasa
a Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
b Public Health Online Programmes, University of Liverpool, United Kingdom
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        "titulo" => "<span class="elsevierStyleItalic">Outcomes</span> cl&#237;nicos da interven&#231;&#227;o coron&#225;ria percut&#226;nea nas oclus&#245;es cr&#243;nicas totais em doentes com diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve showing time until myocardial infarction &#40;mean follow-up of 18 months&#41; in chronic total occlusion patients undergoing percutaneous coronary intervention&#44; compared by diabetes status&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary chronic total occlusions &#40;CTOs&#41; are found in 15&#8211;25&#37; of patients with symptoms of angina or with coronary artery disease &#40;CAD&#41; undergoing a coronary angiogram &#40;CA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Data from retrospective studies and evidence from small randomized controlled trials &#40;RCTs&#41; show that successful recanalization of CTOs by percutaneous coronary intervention &#40;PCI&#41; is associated with improvements not only in quality of life&#44; but also in angina&#44; heart failure &#40;HF&#41; symptoms and left ventricular ejection fraction &#40;LVEF&#41;&#44; although with no statistically significant impact on survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nevertheless&#44; CTO recanalization constitutes less than 5&#37; of PCI procedures in contemporary practice&#44; except in tertiary centers&#59; this may be due to its greater procedural complexity&#44; the risk of complications&#44; and lower success rates in centers with non-specialized teams&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with diabetes have more extensive and complex CAD compared with those without&#44; including higher rates of multivessel disease and CTO vessels&#44; with previous studies showing an incidence of 30&#8211;40&#37; of CTO lesions in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;6</span></a> Although common&#44; CTO PCI is performed less frequently in diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with diabetes and incomplete revascularization have an increased long-term risk of cardiovascular events&#44; and CTO lesions have been shown to be a strong independent predictor of incomplete revascularization in patients undergoing PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> Recent studies suggest similar technical success rates of CTO PCI in diabetic and non-diabetic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Research has also shown the benefits of CTO PCI in diabetic patients&#44; mainly in symptom relief and improved quality of life&#44; but conflicting results and a lack of well-designed RCTs contribute to some controversy involving the treatment of CTO lesions in these groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;4&#44;5&#44;8&#44;12&#44;14</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study aimed to analyze the impact on clinical outcomes and symptom recurrence in type 2 diabetes mellitus &#40;T2DM&#41; patients undergoing CTO PCI&#46; Additionally&#44; we aimed to identify independent predictors of symptom recurrence and clinical outcomes in this group&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A single-center&#44; retrospective cohort analysis with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Recruitment and selection</span><p id="par0045" class="elsevierStylePara elsevierViewall">Eligibility criteria included age &#8805;18 years and a personal history of symptoms suggestive of ischemic heart disease in which a significant atherosclerotic vessel lesion was identified on CA and classified as a CTO &#40;coronary lesion with thrombolysis in myocardial infarction &#91;TIMI&#93; anterograde flow score of 0 with chronic characteristics thought to have been present for at least three months&#41;&#46; Patients who only underwent a diagnostic study&#44; even if they had a CTO vessel&#44; or had an unsuccessful procedure were excluded from the study&#46; A previously published hybrid algorithm for CTO PCI was used for revascularization&#44; and patients were divided into two groups according to their diabetes status &#40;T2DM and non-T2DM&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> T2DM was presumed in patients with a known previous diagnosis of T2DM or with a recorded inpatient random glycated hemoglobin &#8805;6&#46;5&#37;&#46; LVEF was estimated by the modified Simpson&#39;s biplane method&#46; Obesity was defined as a body mass index &#8805;30 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; and chronic renal failure as creatinine clearance of &#60;60 ml&#47;m<span class="elsevierStyleSup">2</span> &#40;Cockcroft&#8211;Gault formula&#41;&#46; Symptoms were assessed through medical records&#59; no scales or questionnaires were applied and no patients were contacted by telephone&#46; The use of at least one antianginal drug&#44; an angiotensin-converting enzyme inhibitor&#47;angiotensin receptor blocker&#47;angiotensin receptor-neprilysin inhibitor&#44; 100 mg aspirin &#40;or anticoagulation in atrial fibrillation&#41;&#44; dual antiplatelet therapy or dual antithrombotic therapy for at least six months&#44; and a lipid-lowering drug &#40;statin and&#47;or ezetimibe&#41; were defined as optimal medical therapy &#40;OMT&#41;&#46; Periprocedural myocardial infarction &#40;MI&#41; was assessed and defined as type 4a in accordance with the fourth universal definition of MI&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> Atherosclerotic disease progression was defined as progression of atherosclerosis in the index vessel and&#47;or in non-CTO vessels&#46; Baseline patient demographic data&#44; cardiovascular risk factors&#44; and clinical&#44; laboratory&#44; echocardiographic and angiographic data were also recorded&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study abides by the ethical requirements stated in the 1975 Helsinki Declaration and received ethical approval by the local hospital ethics committee&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcomes</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study&#39;s primary outcome was recurrence of angina and&#47;or HF symptoms &#40;total symptom recurrence&#41; in a two-year follow-up&#46; HF symptoms were defined as dyspnea and&#47;or fatigue associated with an underlying heart condition&#46; Secondary outcomes were defined as MI and all-cause mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Categorical variables were presented as frequencies and percentages&#44; and continuous variables as means and standard deviation&#44; or medians and interquartile range for variables with skewed distribution or a significant Shapiro&#8211;Wilk test&#46; Comparisons between groups were performed using the chi-square test&#44; Student&#39;s t test or Mann&#8211;Whitney test&#44; as appropriate&#46; Multivariate analysis was performed using logistic and Cox regression to identify predictors associated with the outcomes&#46; A p-value &#60;0&#46;05 was taken to indicate statistical significance&#46; The statistical analysis was performed using IBM SPSS Statistics&#44; version 21&#46;0 &#40;IBM SPSS&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Baseline patient demographics and medical history</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 191 patients were recruited&#44; with 14 being excluded &#40;12 had an unsuccessful procedure and two only underwent CA&#41;&#46; All available characteristics for the final sample of 177 patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The groups were composed of 70 &#40;39&#46;5&#37;&#41; patients with T2DM and 107 &#40;60&#46;5&#37;&#41; without T2DM&#46; The overall sample had a mean age of 64&#46;5&#177;11&#46;4 years and 82&#46;5&#37; were male&#46; Medical history included hypertension in 74&#46;6&#37; of patients&#44; dyslipidemia in 72&#46;9&#37;&#44; obesity in 18&#46;2&#37; and HF in 15&#46;3&#37;&#46; T2DM patients were older&#44; with a mean age of 67&#46;9&#177;10&#46;1 &#40;p&#61;0&#46;010&#41;&#44; and more likely to have chronic renal failure &#40;14&#46;3&#37;&#44; p&#61;0&#46;011&#41;&#46; Most patients were on OMT &#40;83&#46;1&#37;&#44; p&#61;0&#46;382&#41; and antianginal drugs &#40;98&#46;3&#37;&#44; p&#61;0&#46;824&#41;&#44; with no difference regarding diabetes status&#46; Insulin replacement therapy was prescribed in 25 &#40;35&#46;7&#37;&#41; diabetic patients&#44; and mean glycated hemoglobin was 8&#46;2&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Angiographic characteristics of chronic total occlusion patients undergoing percutaneous coronary intervention</span><p id="par0070" class="elsevierStylePara elsevierViewall">The right coronary artery &#40;RCA&#41; was the most frequently occluded artery&#44; and an anterograde approach was most frequently employed&#46; Multivessel disease was present in 85&#46;9&#37; of patients&#46; T2DM patients presented with lower creatinine clearance levels &#40;69&#46;3&#177;27&#46;9 ml&#47;min&#44; p&#61;0&#46;006&#41;&#44; and contrast doses were therefore lower during PCI in these patients &#40;225&#177;84&#46;8 ml&#44; p&#61;0&#46;009&#41;&#46; Ischemia or myocardial viability testing was performed in 43 &#40;24&#46;3&#37;&#44; p&#61;0&#46;718&#41; patients&#44; most frequently stress echocardiography &#40;10&#46;7&#37;&#44; p&#61;0&#46;212&#41;&#46; Periprocedural MI occurred in 10 &#40;5&#46;6&#37;&#44; p&#61;0&#46;976&#41; patients during CTO PCI&#46; The rate of periprocedural complications was 5&#46;1&#37;&#44; mainly vessel perforation &#40;2&#46;26&#37;&#41;&#44; but no differences were found between groups&#46; Although LVEF was mildly reduced at baseline&#44; ventricular function improved in both groups after intervention in a mean follow-up of 18 months &#40;p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Outcomes</span><p id="par0075" class="elsevierStylePara elsevierViewall">The primary outcome &#40;total symptom recurrence&#41; occurred in 16&#46;6&#37; of patients&#44; with no difference between groups &#40;non-T2DM 13&#46;6&#37; vs&#46; T2DM 21&#46;2&#37;&#44; p&#61;0&#46;194&#41; in two-year follow-up &#40;mean follow-up of 18 months&#41;&#46; Angina recurrence was significant higher in the T2DM group &#40;15&#46;2&#37;&#44; p&#61;0&#46;043&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Of the total population&#44; 11 &#40;6&#46;2&#37;&#41; had CTO restenosis and 22 &#40;12&#46;4&#37;&#41; had atherosclerotic disease progression&#44; mainly in the diabetic population &#40;p&#61;0&#46;030 and p&#60;0&#46;001&#44; respectively&#41;&#46; In patients with symptom recurrence &#40;total or isolated angina&#41;&#44; there was no difference in the restenosis rate according to diabetic status &#40;p&#61;0&#46;190 and p&#61;0&#46;790&#44; respectively&#41;&#46; Nevertheless&#44; atherosclerotic disease progression was more frequent in diabetic patients with total symptom or angina recurrence &#40;p&#61;0&#46;008 and p&#61;0&#46;013&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">MI and all-cause mortality showed no differences between groups &#40;T2DM 1&#46;5&#37;&#44; p&#61;0&#46;786 and 4&#46;5&#37;&#44; p&#61;0&#46;352&#44; respectively&#44; on survival analysis&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Independent predictors for primary and secondary outcomes</span><p id="par0090" class="elsevierStylePara elsevierViewall">The presence of T2DM and LVEF was not independent predictors of the primary outcome &#40;p&#61;0&#46;429&#44; hazard ratio &#91;HR&#93; 1&#46;37&#44; 95&#37; confidence interval &#91;CI&#93; 0&#46;62&#8211;2&#46;98 and p&#61;0&#46;737&#44; HR 0&#46;994&#44; 95&#37; CI 0&#46;95&#8211;1&#46;03&#44; respectively&#41;&#46; RCA as the CTO vessel was an independent predictor for total symptom recurrence after PCI &#40;p&#61;0&#46;019&#44; HR 2&#46;68&#44; 95&#37; CI 1&#46;17&#8211;6&#46;14&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Independent predictors of all-cause mortality were LVEF and creatine clearance &#40;p&#61;0&#46;039&#44; HR 0&#46;92&#44; 95&#37; CI 0&#46;85&#8211;0&#46;99 and p&#61;0&#46;013&#44; HR 0&#46;96&#44; 95&#37; CI 0&#46;93&#8211;0&#46;99&#44; respectively&#41;&#46; The presence of T2DM was not an independent predictor of all-cause mortality &#40;p&#61;0&#46;975&#44; HR 1&#46;03&#44; 95&#37; CI 0&#46;16&#8211;6&#46;34&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study found that recanalization of CTO lesions by PCI and its benefit in terms of clinical outcomes and symptom recurrence were independent of T2DM status&#46; However&#44; recurrence of angina was more common in diabetics&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The sample included 40&#37; of patients with T2DM&#44; with a mean age of 65 years and mainly male&#44; of whom almost three quarters had a medical history of hypertension and dyslipidemia&#44; and a mean LVEF of 47&#37; was observed&#46; Sample characteristics were similar to those in other recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;8&#44;12&#44;13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Focusing on the procedure itself&#44; Salisbury et al&#46; reported that 60&#37; of CTOs affected the RCA and an anterograde approach was adopted in 38&#8211;42&#37; of cases&#46; In the present study&#44; the RCA was also the most commonly affected artery &#40;45&#37;&#41;&#44; while an anterograde approach was employed more often than in Salisbury et al&#46;&#8217;s study &#40;89&#37;&#41;&#46; The rate of periprocedural complications was low&#44; mainly vessel perforation &#40;2&#37;&#41;&#44; and lower than described by Salisbury et al&#46; &#40;who reported perforation in 8&#8211;9&#37; of cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Symptom recurrence after a two-year follow-up was low &#40;16&#46;6&#37;&#41;&#44; with no difference found between groups&#46; In addition&#44; T2DM was not an independent predictor of symptom recurrence&#46; Similarly&#44; Salisbury et al&#46; and Zhao et al&#46; reported angina improvement of almost 20 points on the Seattle Angina Questionnaire angina frequency score and dyspnea relief during the first year after recanalization&#44; independently of diabetes status&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;12</span></a> Notwithstanding&#44; in the present analysis&#44; recurrence of isolated angina was more frequent in T2DM patients &#40;15&#37;&#44; p&#61;0&#46;043&#41;&#46; This could be related to poorer disease control &#40;mean glycated hemoglobin was 8&#46;2&#37;&#41;&#44; which affects atherosclerotic disease progression&#46; Even in patients with relatively controlled disease&#44; there is evidence that progression of CAD is difficult to stop&#44; with higher rates of angina recurrence after PCI&#46; Although rates of stent restenosis and atherosclerotic disease progression were higher in the diabetic population&#44; as expected&#44; in patients with total symptom or isolated angina recurrence there was no significant difference in stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Most patients were on OMT and taking antianginal drugs&#44; regardless of diabetic status&#44; which probably contributed to the low rate of symptom recurrence reported&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Revascularization of RCA CTO and creatine clearance were independent predictors of total symptom recurrence and all-cause mortality&#44; respectively&#46; Patients with T2DM showed higher rates of RCA CTO &#40;although this was not statistically significant&#41; and significantly lower levels of creatine clearance&#44; which may have affected outcomes&#44; particularly angina recurrence&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We reported an improvement in LVEF from baseline to post-procedure assessment&#44; from mildly reduced to preserved in both groups without statistical difference&#44; which could have influenced the lower rates of HF symptoms reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">To date&#44; only two studies have reported that successful CTO PCI relieved symptoms of angina and dyspnea regardless of diabetes diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;12</span></a> Our study corroborates these results&#44; and further highlights that successful CTO PCI could represent an effective strategy regardless of T2DM status&#46; Further studies are needed to compare the outcomes of CTO PCI in T2DM patients&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Limitations</span><p id="par0140" class="elsevierStylePara elsevierViewall">Some limitations should be acknowledged&#46; This was an observational study&#44; therefore the data collected are limited to medical records&#46; Patient symptoms were not assessed by scales or questionnaires&#44; which could increase ambiguity&#46; Our study included only successful CTO PCI&#59; failed CTO PCI was not addressed&#44; which may limit the validity of the conclusions&#46; Finally&#44; the data in our study are from only one CTO PCI center&#44; so our conclusions may not be generalizable to other cardiac centers&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">The presence of T2DM did not influence total symptom recurrence or clinical outcomes in CTO patients undergoing revascularization by PCI in a two-year follow-up&#44; despite a markedly higher recurrence of angina in this group&#46; These results support the premise that diabetes should not be an impediment when opting for CTO PCI&#44; which in fact may be an effective strategy in preventing symptom recurrence in this group&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Limitations"
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        10 => array:2 [
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          "titulo" => "Conclusion"
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          "identificador" => "sec0075"
          "titulo" => "Conflicts of interest"
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        12 => array:2 [
          "identificador" => "xack736318"
          "titulo" => "Acknowledgments"
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        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-03-21"
    "fechaAceptado" => "2023-07-17"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1801598"
          "palabras" => array:4 [
            0 => "Chronic total occlusions"
            1 => "Type 2 diabetes"
            2 => "Symptom recurrence"
            3 => "Clinical outcomes"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1801597"
          "palabras" => array:4 [
            0 => "Oclus&#245;es totais cr&#243;nicas"
            1 => "Diabetes tipo 2"
            2 => "Recorr&#234;ncia de sintomas"
            3 => "<span class="elsevierStyleItalic">Outcomes</span> cl&#237;nicos"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary chronic total occlusions &#40;CTOs&#41; are relatively common findings in patients with type 2 diabetes mellitus &#40;T2DM&#41;&#46; However&#44; the indication for percutaneous coronary intervention &#40;PCI&#41; and its clinical benefit in these patients remain controversial&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020&#46; Patients were divided into two groups according to previous T2DM diagnosis &#40;T2DM and non-T2DM&#41;&#46; The primary outcome was recurrence of angina and&#47;or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 177 patients &#40;82&#46;5&#37; male&#41; were included in the analysis&#44; with a mean age of 65&#177;11 years&#46; The primary outcome &#40;total symptom recurrence&#41; occurred in 16&#46;6&#37; of the sample&#44; with no difference between groups &#40;non-T2DM 13&#46;6&#37; vs&#46; T2DM 21&#46;2&#37;&#44; p&#61;0&#46;194&#41; in a two-year follow-up&#46; Angina recurrence was significantly more frequent in T2DM patients &#40;15&#46;2&#37;&#44; p&#61;0&#46;043&#41;&#46; The presence of T2DM was not an independent predictor of symptom recurrence &#40;p&#61;0&#46;429&#44; HR 1&#46;37&#44; 95&#37; CI 0&#46;62&#8211;2&#46;98&#41;&#46; Myocardial infarction and all-cause mortality were also not different between groups &#40;T2DM 1&#46;5&#37;&#44; p&#61;0&#46;786 and 4&#46;5&#37;&#44; p&#61;0&#46;352&#44; respectively&#44; on survival analysis&#41;&#46; Independent predictors of all-cause mortality were left ventricular function and creatine clearance &#40;p&#61;0&#46;039&#44; HR 0&#46;92&#44; 95&#37; CI 0&#46;85&#8211;0&#46;99 and p&#61;0&#46;013&#44; HR 0&#46;96&#44; 95&#37; CI 0&#46;93&#8211;0&#46;99&#44; respectively&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">T2DM did not influence outcomes in CTO patients undergoing PCI&#44; and its presence should not be a limiting factor in deciding on CTO revascularization&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
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            "titulo" => "Methods"
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            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As oclus&#245;es totais cr&#243;nicas &#40;CTO&#41; s&#227;o achados comuns em doentes com diabetes tipo 2 &#40;DM2&#41;&#46; A indica&#231;&#227;o para revasculariza&#231;&#227;o percut&#226;nea &#40;PCI&#41; e o seu benef&#237;cio cl&#237;nico permanecem controversos&#46; Este estudo foi desenhado para tentar responder a esta quest&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo de coorte retrospetivo com colheita de dados prospetiva&#44; realizada em doentes com CTO submetidos a PCI entre 2019-2020&#46; Formados dois grupos &#40;DM2 e n&#227;o-DM2&#41;&#46; O <span class="elsevierStyleItalic">outcome</span> prim&#225;rio foi definido como a recorr&#234;ncia de sintomas de angor e&#47;ou insufici&#234;ncia card&#237;aca e os <span class="elsevierStyleItalic">outcomes</span> secund&#225;rios a ocorr&#234;ncia de enfarte do mioc&#225;rdio e mortalidade por todas as causas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise com 177 doentes&#44; idade m&#233;dia de 65&#177;11 anos e 82&#44;5&#37; do sexo masculino&#46; O <span class="elsevierStyleItalic">outcome</span> prim&#225;rio ocorreu em 16&#44;6&#37; dos doentes&#44; sem diferen&#231;a entre os grupos &#40;n&#227;o-DM2 13&#44;6&#37; <span class="elsevierStyleItalic">versus</span> DM2 21&#44;2&#37;&#44; p&#61;0&#44;194&#41; em dois anos&#46; A recorr&#234;ncia de angor foi significativamente maior nos doentes com DM2 &#40;15&#44;2&#37;&#44; p&#61;0&#44;043&#41;&#46; A DM2 n&#227;o foi um preditor independente do <span class="elsevierStyleItalic">outcome</span> prim&#225;rio &#40;p&#61;0&#44;429&#44; HR 1&#44;37&#44; 95&#37; CI 0&#44;62 a 2&#44;98&#41;&#46; A ocorr&#234;ncia de enfarte e mortalidade n&#227;o mostrou diferen&#231;as entre os grupos &#40;DM2 1&#44;5&#37;&#44; p&#61;0&#44;786 e 4&#44;5&#37;&#44; p&#61;0&#44;352&#44; respetivamente &#8211; an&#225;lise de sobreviv&#234;ncia&#41;&#46; A fun&#231;&#227;o ventricular esquerda e a <span class="elsevierStyleItalic">clearance</span> de creatinina foram preditores independentes de mortalidade &#40;p&#61;0&#44;039&#44; HR 0&#44;92&#44; 95&#37; CI 0&#44;85 a 0&#44;99 e p&#61;0&#44;013&#44; HR 0&#44;96&#44; 95&#37; CI 0&#44;93 a 0&#44;99&#44; respetivamente&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A DM2 n&#227;o influenciou os <span class="elsevierStyleItalic">outcomes</span> nos doentes com CTO submetidos a PCI&#44; sendo que a sua presen&#231;a n&#227;o dever&#225; ser um fator limitativo na decis&#227;o de revasculariza&#231;&#227;o&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e objetivos"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve showing time until myocardial infarction &#40;mean follow-up of 18 months&#41; in chronic total occlusion patients undergoing percutaneous coronary intervention&#44; compared by diabetes status&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curve showing time until death &#40;mean follow-up of 18 months&#41; in chronic total occlusion patients undergoing percutaneous coronary intervention&#44; compared by diabetes status&#46;</p>"
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis &#40;Cox regression&#41; for the primary outcome&#46; CTO&#58; chronic total occlusion&#59; HR&#58; hazard ratio&#59; LVEF&#58; left ventricular ejection fraction&#59; RCA&#58; right coronary artery&#59; T2DM&#58; type 2 diabetes mellitus&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ACS&#58; acute coronary syndrome&#59; CCS&#58; Canadian Cardiovascular Society&#59; DAPT&#58; dual antiplatelet therapy&#59; DAT&#58; dual antithrombotic therapy&#59; HF&#58; heart failure&#59; OAC&#58; oral anticoagulant therapy&#59; OMT&#58; optimal medical therapy&#59; PCI&#58; percutaneous coronary intervention&#59; SD&#58; standard deviation&#59; T2DM&#58; type 2 diabetes mellitus&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">History of HF&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Approach&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antegrade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93&#46;0 &#40;86&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#46;0 &#40;91&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;88&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retrograde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;00 &#40;8&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&#46;0 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">J-CTO score&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&#177;0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&#177;0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&#177;0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Radiation dose</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Air kerma&#44; mGy&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1840 &#40;2030&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1932 &#40;1804&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2043 &#40;1784&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kerma area product&#44; Gy<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;113&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;113&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;810&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ischemia&#47;viability test&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#46;0 &#40;25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#46;0 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#46;0 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;718&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stress echocardiography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;0 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;00 &#40;7&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#46;0 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SPECT-MPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00 &#40;2&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00 &#40;4&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;00 &#40;3&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0 &#40;9&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;00 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;0 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;654&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF at baseline&#44; &#37;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&#177;10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;2&#177;10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF after PCI&#44; &#37;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;6&#177;9&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;2&#177;9&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;2&#177;9&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">69&#46;3&#177;27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">77&#46;1&#177;26&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PCI time&#44; min&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136&#177;56&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">126&#177;65&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&#177;56&#46;0&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T2DM&#40;n&#61;70&#44; 39&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CTO restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;00 &#40;1&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;00 &#40;5&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Disease progression&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;00 &#40;3&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Total symptom recurrence&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;n&#61;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n&#61;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CTO restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;00 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;00 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;00 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;190&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disease progression&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;00 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;0 &#40;78&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angina recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n&#61;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n&#61;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CTO restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;00 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;00 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;00 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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ISSN: 08702551
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