Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patientsopen access
- Authors
- Cha, Jung-Joon; Hong, Soon Jun; Kim, Ju Hyeon; Lim, Subin; Joo, Hyung Joon; Park, Jae Hyoung; Yu, Cheol Woong; Kang, Jeehoon; Kim, Hyo-Soo; Gwon, Hyeon-Cheol; Chun, Woo Jung; Hur, Seung-Ho; Han, Seung Hwan; Rha, Seung-Woon; Chae, In-Ho; Jeong, Jin-Ok; Heo, Jung Ho; Yoon, Junghan; Park, Jong-Seon; Hong, Myeong-Ki; Doh, Joon-Hyung; Cha, Kwang Soo; Kim, Doo-Il; Lee, Sang Yeub; Chang, Kiyuk; Hwang, Byung-Hee; Choi, So-Yeon; Jeong, Myung Ho; Song, Young Bin; Choi, Ki Hong; Nam, Chang-Wook; Koo, Bon-Kwon; Lim, Do-Sun
- Issue Date
- Dec-2022
- Publisher
- Frontiers Media S.A.
- Keywords
- coronary bifurcation angioplasty; diabetes mellitus; stent strategy; second-generation drug-eluting stent; clinical outcome; percutaneous coronary intervention (complex PCI)
- Citation
- Frontiers in Cardiovascular Medicine, v.9
- Indexed
- SCIE
SCOPUS
- Journal Title
- Frontiers in Cardiovascular Medicine
- Volume
- 9
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62177
- DOI
- 10.3389/fcvm.2022.1018802
- ISSN
- 2297-055X
2297-055X
- Abstract
- 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.
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.
Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03068494?term=03068494&draw=2&rank=1, identifier: NCT03068494
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