Diabetes-Centered Evaluation of Revascularization Strategy of Functional and Imaging-CombiNEd State-of-the-Art Percutaneous Coronary Intervention or Coronary-Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease

NCT ID: NCT05831085

Last Updated: 2025-11-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-14

Study Completion Date

2027-12-31

Brief Summary

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The objective of this randomized study was to compare outcomes of imaging-and physiology-guided state-of-the-art percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in patients with diabetes and three-vessel CAD (not involving left main).

Detailed Description

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Conditions

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Coronary Artery Stenosis

Keywords

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Multivessel Coronary Artery Disease state of the art State-of-the-Art Percutaneous Coronary Intervention Coronary-Artery Bypass Grafting Diabetes Mellitus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Imaging- and Physiology-Guided State-of-the-Art Percutaneous Coronary Intervention

Group Type EXPERIMENTAL

State-of-the-Art Percutaneous Coronary Intervention

Intervention Type PROCEDURE

supported by intracoronary imaging (e.g., intravascular ultrasound \[IVUS\] or optical coherence tomography \[OCT\]), intracoronary physiology (e.g., fractional flow reserve \[FFR\] or instantaneous wave-free ratio \[iFR\]), contemporary metallic DES (durable polymer everolimus-eluting stents; XIENCE family stent system, Abbott Vascular), guideline-directed optimal medical therapy \[GDMT\] with advanced cardiovascular (e.g., high-dose statin and advanced strategy of antiplatelet regimens) and anti-diabetic medications \[e.g., a sodium-glucose cotransporter \[SGLT\]-2 inhibitors or Glucagon-like peptide-1 \[GLP-1\] agonists) in patients with type 2 diabetes and three-vessel coronary artery disease (CAD) (not involving left main)

Coronary-Artery Bypass Grafting

Group Type ACTIVE_COMPARATOR

standard CABG

Intervention Type PROCEDURE

Coronary-Artery Bypass Grafting

Interventions

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State-of-the-Art Percutaneous Coronary Intervention

supported by intracoronary imaging (e.g., intravascular ultrasound \[IVUS\] or optical coherence tomography \[OCT\]), intracoronary physiology (e.g., fractional flow reserve \[FFR\] or instantaneous wave-free ratio \[iFR\]), contemporary metallic DES (durable polymer everolimus-eluting stents; XIENCE family stent system, Abbott Vascular), guideline-directed optimal medical therapy \[GDMT\] with advanced cardiovascular (e.g., high-dose statin and advanced strategy of antiplatelet regimens) and anti-diabetic medications \[e.g., a sodium-glucose cotransporter \[SGLT\]-2 inhibitors or Glucagon-like peptide-1 \[GLP-1\] agonists) in patients with type 2 diabetes and three-vessel coronary artery disease (CAD) (not involving left main)

Intervention Type PROCEDURE

standard CABG

Coronary-Artery Bypass Grafting

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. The subject must be ≥20 years of age with angina and/or evidence of myocardial ischemia.
2. Patients with type 2 diabetes based on the need for treatment with insulin or oral hypoglycemic drugs or a confirmed elevated blood glucose level (fasting plasma glucose elevation on \>1 occasion of ≥126 mg/dL \[7.0 mmol/L\] or 2-h postprandial of ≥200 mg/dL \[11.1 mmol/L\] during oral glucose tolerance test or random plasma glucose of ≥200 mg/dL \[11.1 mmol/L\] with classic symptoms of hyperglycemia or hyperglycemic crisis or HbA1C ≥6.5% \[48 mmol/mol\]).
3. Significant three-vessel CAD (defined as ≥ 50% diameter stenosis \[DS\] by visual estimation in each of the three major epicardial vessels or major side branches but not involving the left main coronary artery) and equivalently amenable to revascularization by means of either PCI or CABG as determined by the Heart Team at the trial site.
4. The patient or guardian agrees to the study protocol and the schedule of clinical follow-up, and provides informed, written consent, as approved by the appropriate Institutional Review Board/Ethical Committee of the respective clinical site.

Exclusion Criteria

1. Unprotected left main coronary artery disease.
2. The presence of complex coronary disease anatomy or lesion characteristics or other cardiac condition(s) which leads the participating interventional cardiologist to believe that PCI is not suitable (i.e. the subject should be managed with CABG or medical therapy alone).
3. Recent ST-elevation myocardial infarction(\<5 days prior to randomization).
4. Cardiogenic shock and/or need for mechanical/pharmacologic hemodynamic support.
5. Severe left ventricular dysfunction (ejection fraction \<30%).
6. Requirement for other cardiac or non-cardiac surgical procedure (e.g., valve replacement, aorta surgery, or carotid revascularization). However, a maze procedure or pulmonary vein isolation is allowed.
7. Contraindication or inability to take aspirin or P2Y12 inhibitors (clopidogrel, ticagrelor, or prasugrel) for at least 6 months.
8. Prior CABG.
9. Extremely calcified or tortuous vessels precluding FFR measurement or intracoronary imaging evaluation.
10. More than one major epicardial vessel which is chronically occluded; enrollment of 1 Chronic total occlusion lesion is allowed.
11. Subjects requiring or who may require additional surgery (cardiac or noncardiac) within 1 year.
12. End-stage renal disease requiring renal replacement therapy.
13. Liver cirrhosis.
14. Pregnant and/or lactating women.
15. Concurrent medical condition with a limited life expectancy of less than 2 years.
16. Patients who are actively participating in another drug or device investigational study, which have not completed the primary endpoint follow-up period. However, where at least one or more conditions are satisfied, it could be an exception according to an investigator's discretion;

1\) Participated in the observational study expected no effect on the safety and/or effectiveness evaluation of this trial.

2\) Screening failed before any interventional factor is involved.

3\) Participated in academic trials like strategic comparison studies conducted under standard therapy provided that there is no additional risk or a specific procedure to a subject and no interference between this trial and other studies.
Minimum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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CardioVascular Research Foundation, Korea

OTHER

Sponsor Role collaborator

Duk-Woo Park, MD

OTHER

Sponsor Role lead

Responsible Party

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Duk-Woo Park, MD

Professor, Cardiology, Asan Medical Center Heart Institute, Valvular Heart Disease Center, Ischemic Heart Disease Center

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Seung-jung Park, MD

Role: STUDY_CHAIR

Asan Medical Center

Locations

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Palo Alto VA Medical Center

Palo Alto, California, United States

Site Status NOT_YET_RECRUITING

Second Affiliated Hospital of Zhejiang University School of Medicine

Hanzhou, , China

Site Status RECRUITING

Sarawak Heart Centre

Kota Samarahan, , Malaysia

Site Status RECRUITING

Daegu Catholic University Medical Center

Daegu, , South Korea

Site Status NOT_YET_RECRUITING

Keimyung University Dongsan Medical Center

Daegu, , South Korea

Site Status RECRUITING

Yeungnam University Medical Center

Daegu, , South Korea

Site Status NOT_YET_RECRUITING

Chungnam National University Hospital

Daejeon, , South Korea

Site Status NOT_YET_RECRUITING

Konyang University Hospital

Daejeon, , South Korea

Site Status NOT_YET_RECRUITING

Gangneung Asan Hospital

Gangneung, , South Korea

Site Status NOT_YET_RECRUITING

Chonnam National University Hospital

Gwangju, , South Korea

Site Status RECRUITING

National Health Insurance Service Ilsan Hospital

Ilsan, , South Korea

Site Status RECRUITING

Gachon University Gil Hospital

Incheon, , South Korea

Site Status NOT_YET_RECRUITING

Dong-A Medical Center

Pusan, , South Korea

Site Status RECRUITING

Asan Medical Center

Seoul, , South Korea

Site Status RECRUITING

Hanyang University Seoul Hospital

Seoul, , South Korea

Site Status NOT_YET_RECRUITING

The Catholic University of Korea, Uijeongbu ST. Mary's Hospital

Uijeongbu-si, , South Korea

Site Status RECRUITING

Ulsan University Hospital

Ulsan, , South Korea

Site Status RECRUITING

National Taiwan University Hospital

Taipei, , Taiwan

Site Status NOT_YET_RECRUITING

Siriraj Hospital

Bangkok, , Thailand

Site Status RECRUITING

Countries

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United States China Malaysia South Korea Taiwan Thailand

Central Contacts

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Jung-hee Ham, Project manager

Role: CONTACT

Phone: 82-2-3010-4728

Email: [email protected]

Facility Contacts

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Fearon F. William, MD

Role: primary

Jian'an Wang, MD

Role: primary

Alan Pong, MD

Role: primary

Jin-bae Lee, MD

Role: primary

Chul-hyun Lee, MD

Role: primary

Woong Kim, MD

Role: primary

Jin-ok Jeong, MD

Role: primary

Taek-keun Kwon, MD

Role: primary

Han-bit Park, MD

Role: primary

Young-keun Ahn, MD

Role: primary

Ji-yong Jang, MD

Role: primary

Seung-hwan Han, MD

Role: primary

Yong-rak Cho, MD

Role: primary

Duk-woo Park, MD

Role: primary

Young-hyo Lim, MD

Role: primary

Hyo-seok Ahn, MD

Role: primary

Eun-seok Shin, MD

Role: primary

Paul Hsien Li Kao, MD

Role: primary

Karokoth Towashiraporn, MD

Role: primary

Other Identifiers

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AMCCV2023-03

Identifier Type: -

Identifier Source: org_study_id