AUTHOR=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 

TITLE=Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1018802

DOI=10.3389/fcvm.2022.1018802

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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%, <italic>p</italic> &lt; 0.001), whereas no difference was observed in TLF between the one-stent strategy and crush or culotte technique (7.3 vs. 5.9%, <italic>p</italic> = 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; <italic>p</italic> &lt; 0.001). Chronic kidney disease, reduced left ventricular ejection fraction, and left main bifurcation were independent predictors of TLF in patients with DM.</p></sec><sec><title>Conclusion</title><p>T- or V-stenting in patients with DM resulted in increased cardiovascular events after second-generation DES implantation.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03068494?term=03068494&amp;draw=2&amp;rank=1" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT03068494?term=03068494&amp;draw=2&amp;rank=1</ext-link>, identifier: NCT03068494.</p></sec>