Comparison of long-term clinical outcomes in diabetic and non-diabetic patients of the mini-crush two-stent technique for percutaneous treatment of complex coronary artery bifurcation lesions

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Diabetic patients present more aggressive coronary artery disease and worse outcomes after percutaneous coronary intervention (PCI), especially in complex coronary bifurcation lesions. Currently, the benefit of "double stenting" techniques in the treatment of complex bifurcations in diabetics with coronary artery disease, is controversial. Purpose The aim of this study was to compare the outcomes of PCI with "mini-crush" two-stent technique in diabetic and non-diabetic patients, in terms of MACE: cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after long follow-up (median 32 months). Methods Observational study in which were included 152 consecutive patients (mean age 69.5 years, 38.3% diabetics) with 152 complex bifurcated coronary severe lesions that underwent PCI from April 2014 to April 2020. Results No significant differences were observed in the baseline characteristics, clinical presentation and antiplatelet pretreatment between both groups. Clopidogrel was the P2Y12-receptor inhibitor most commonly used. There were no differences in mean complexity according to the Syntax score (29.7 ± 11.3 in diabetics vs 30.4 ± 14.4 in non-diabetics, p=0.293). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. The characteristics of the procedure was similar in both groups: no differences observed in pre-dilation rate either in final kissing balloon post-dilation rate. Similar length and diameter of the stents implanted in both groups. Angiographic follow-up clinically guided was 15.8% in diabetics and 16.9% in non-diabetics. We found no significant differences in the incidence of MACE or in any of its components separately. TLR rate was similar in diabetics and non-diabetics patients. Conclusions Comparable to non-diabetic patients, PCI in complex coronary bifurcation lesions with "mini-crush" two-stent technique in diabetic patients shows favorable results with low event rates and need for revascularization at long-term follow-up.