Objectives Although there are increasing data suggesting that patients could get survival advantage from the recanalising procedure of coronary chronic total occlusion (CTO) as compared with optimal medical treatment (OMT) alone, it still remains unclear whether diabetic patients could get similar benefits from this procedure.

Methods A total of 239 diabetic patients with CTO who underwent percutaneous coronary intervention (PCI group, n = 97) or OMT alone (OMT group, n = 142) from Jan 2004 to Dec 2010 were enrolled into this study. All patients received OMT as per existing guidelines. Various clinical outcomes at 2 years were compared between the two groups.

Results The baseline clinical characteristics didn’t differ significantly between the two groups. But, OMT group had a higher rate of multi-vessel disease as compared with PCI group (84.5% vs. 43.2%, P < 0.001). Two-year clinical outcomes showed that PCI group had significantly lower rates of all cause death and major adverse cardiac events (composite of all cause death, myocardial infarction and revascularisation) as compared with OMT alone group. However, multivariable logistic analysis revealed that OMT alone (vs. PCI) was not an independent predictor for all cause death [odds ratio (OR) 2.35, confidential interval (CI) 0.44-12.4, P = 0.314) or MACE (OR 1.99, CI 0.85-4.64, P = 0.110).

Conclusions The current data failed to show significant advantages of recanalising coronary CTO over OMT alone in diabetic patients, suggesting this aggressive recanlisation might be a thankless job in this subset of patients.