Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients
Authors
Jung-Joon Cha ; Soon Jun Hong ; Ju Hyeon Kim ; Subin Lim ; Hyung Joon Joo ; Jae Hyoung Park ; Cheol Woong Yu ; Jeehoon Kang ; Hyo-Soo Kim ; Hyeon-Cheol Gwon ; Woo Jung Chun ; Seung-Ho Hur ; Seung Hwan Han ; Seung-Woon Rha ; In-Ho Chae ; Jin-Ok Jeong ; Jung Ho Heo ; Junghan Yoon ; Jong-Seon Park ; Myeong-Ki Hong ; Joon-Hyung Doh ; Kwang Soo Cha ; Doo-Il Kim ; Sang Yeub Lee ; Kiyuk Chang ; Byung-Hee Hwang ; So-Yeon Choi ; Myung Ho Jeong ; Young Bin Song ; Ki Hong Choi ; Chang-Wook Nam ; Bon-Kwon Koo ; Do-Sun Lim
Citation
FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol.9 : 1018802, 2022-12
Background: Diabetes mellitus (DM) is a critical risk factor for the pathogenesis and progression of coronary artery disease, with a higher prevalence of complex coronary artery disease, including bifurcation lesions. This study aimed to elucidate the optimal stenting strategy for coronary bifurcation lesions in patients with DM.
Methods: A total of 905 patients with DM and bifurcation lesions treated with second-generation drug-eluting stents (DES) from a multicenter retrospective patient cohort were analyzed. The primary outcome was the 5-year incidence of target lesion failure (TLF), which was defined as a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization.
Results: Among all patients with DM with significant bifurcation lesions, 729 (80.6%) and 176 (19.4%) were treated with one- and two-stent strategies, respectively. TLF incidence differed according to the stenting strategy during the mean follow-up of 42 ± 20 months. Among the stent strategies, T- and V-stents were associated with a higher TLF incidence than one-stent strategy (24.0 vs. 7.3%, p < 0.001), whereas no difference was observed in TLF between the one-stent strategy and crush or culotte technique (7.3 vs. 5.9%, p = 0.645). The T- or V-stent technique was an independent predictor of TLF in multivariate analysis (hazard ratio, 3.592; 95% confidence interval, 2.117-6.095; p < 0.001). Chronic kidney disease, reduced left ventricular ejection fraction, and left main bifurcation were independent predictors of TLF in patients with DM.
Conclusion: T- or V-stenting in patients with DM resulted in increased cardiovascular events after second-generation DES implantation.