In patients undergoing PCI for coronary bifurcation lesions, diabetes mellitus was associated with significantly higher risks of MACE (RR range 1.73-1.92) and MI (RR range 1.90-2.16).
Meta-Analysis (n=12,494)
Does diabetes mellitus worsen long-term clinical outcomes in patients undergoing PCI for coronary bifurcation lesions?
Diabetes mellitus is associated with significantly worse long-term ischemic outcomes, including MACE and MI, in patients undergoing PCI for coronary bifurcation lesions.
Effect estimate: RR 1.73-1.92
Abstract Introduction Percutaneous coronary intervention (PCI) in coronary bifurcation lesions is technically complex and associated with higher adverse event rates. Diabetes mellitus (DM) worsens outcomes through diffuse atherosclerosis and a prothrombotic, proinflammatory state, even with drug-eluting stents. However, the specific impact of DM on bifurcation PCI outcomes remains unclear. This study aims to evaluate the effect of DM on long-term clinical outcomes after PCI for coronary bifurcation lesions through a systematic review and meta-analysis. Methods We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO-registered). PubMed, Cochrane, Web of Science, and Scopus were searched through August 2025. Observational studies comparing the clinical impact of diabetes mellitus in patients with coronary bifurcation lesions were eligible if they reported mortality, myocardial infarction (MI), or bleeding. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results Five retrospective studies and one prospective study comprising 12,494 patients undergoing percutaneous coronary intervention (PCI) for coronary bifurcation lesions (involving both left main and non–left main locations) were included, with diabetes prevalence ranging from 33% to 50%. Across all follow-up periods, diabetes was consistently associated with worse outcomes. Diabetic patients had significantly higher risks of MACE from 9 months to 2 years (RR range 1.73–1.92) and increased myocardial infarction rates up to 5 years (RR range 1.90–2.16). Diabetes was also associated with higher cardiac mortality at 9 months (RR 1.96) and increased target lesion revascularization from 9 months to 2 years (RR range 1.61–1.82). No significant association was observed between diabetes and stent thrombosis. Conclusion In patients undergoing PCI for coronary bifurcation lesions, diabetes mellitus is associated with significantly worse long-term clinical outcomes, including higher rates of MACE, myocardial infarction and repeat revascularization. Despite contemporary drug-eluting stent use, diabetic patients remain at increased ischemic risk, underscoring the need for tailored revascularization strategies and optimized metabolic and procedural management in this high-risk population.
Motta et al. (Sat,) conducted a meta-analysis in Coronary bifurcation lesions (n=12,494). Diabetes mellitus vs. Without diabetes mellitus was evaluated on Major adverse cardiovascular events (MACE) from 9 months to 2 years (RR 1.73-1.92). In patients undergoing PCI for coronary bifurcation lesions, diabetes mellitus was associated with significantly higher risks of MACE (RR range 1.73-1.92) and MI (RR range 1.90-2.16).