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

Cha, JJ | Hong, SJ | Kim, JH | Lim, S | Joo, HJ | Park, JH | Yu, CW | Kang, J | Kim, HS | Gwon, HC | Chun, WJ | Hur, SH | Han, SH | Rha, SW | Chae, IH | Jeong, JO | Heo, JH | Yoon, J | Park, JS | Hong, MK | Doh, JH | Cha, KS | Kim, DI | Lee, SY | Chang, K | Hwang, BH | Choi, SY  | Jeong, MH | Song, YB | Choi, KH | Nam, CW | Koo, BK | Lim, DS
Frontiers in cardiovascular medicine, 9. : 1018802-1018802, 2022
Journal Title
Frontiers in cardiovascular medicine
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:, identifier: NCT03068494.

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Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
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최, 소연
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