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

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 HongJoon 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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number1018802
JournalFrontiers in Cardiovascular Medicine
Publication statusPublished - 2022 Dec 21

Bibliographical note

Publisher Copyright:
Copyright © 2022 Cha, Hong, Kim, Lim, Joo, Park, Yu, Kang, Kim, Gwon, Chun, Hur, Han, Rha, Chae, Jeong, Heo, Yoon, Park, Hong, Doh, Cha, Kim, Lee, Chang, Hwang, Choi, Jeong, Song, Choi, Nam, Koo and Lim.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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