Key result
Diabetes linked to ~67% higher 10-year mortality after PCI with DES.
Why the study?
Diabetes is a significant predictor of adverse cardiovascular events following PCI, but comprehensive data on very long-term outcomes in the era of DES remain limited.
Does baseline diabetes mellitus increase the risk of 10-year all-cause mortality and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention with drug-eluting stents?
Meta-Analysis (n=9,699)
Yes
Does baseline diabetes mellitus increase the risk of 10-year all-cause mortality and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention with drug-eluting stents?
In a pooled patient-level analysis of five RCTs, baseline diabetes mellitus independently increased the 10-year risk of all-cause mortality, cardiovascular death, stent thrombosis, and repeat revascularization following PCI with drug-eluting stents.
Diabetes elevates long-term post-PCI mortality risk; extends prior observational data but leaves open targeted interventions.
Background Diabetes is a significant predictor of adverse cardiovascular events following percutaneous coronary intervention (PCI). However, comprehensive data on very long-term outcomes in the era of drug-eluting stents (DES) is still limited. Purpose To assess the impact of diabetes on clinical outcomes after PCI with DES over a 10-year period, using individual patient-level data from randomised controlled trials (RCTs). Methods We pooled individual patient data from five RCTs with a 10-year follow-up. Patients were divided into two groups according to their diabetic status at baseline. The primary endpoint was all-cause mortality. The secondary endpoints were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST), target lesion revascularisation (TLR), target vessel revascularisation (TVR) and non-target vessel revascularisation (nTVR). Results Of the 9,699 patients, 2,298 (31%) had diabetes mellitus at baseline. Over a period of up to 10 years, diabetic patients were found to be at a higher risk than nondiabetic patients regarding all-cause death (41.3% vs. 26.4%; HRadj:1.67 [95% CI, 1.59–1.77]); cardiovascular death, (23.5% vs. 12.9%; HRadj: 1.74 [1.61–1.87]); MI (HRadj: 1.29 [0.92 - 1.80]); definite ST (HRadj: 1.44 [1.11 – 2.14]); TLR (HRadj: 1.35 [1.21 – 1.51]); TVR (HRadj: 1.28 [1.14 – 1.43]) and nTVR (HRadj:1.23 [1.09 – 1.40]). Statistically significant interactions were found for most outcomes between diabetes and age (a stronger impact of diabetes in patients under 75 years old), sex (a stronger impact of diabetes in women), clinical presentation (a stronger impact of diabetes in patients with acute coronary syndromes) and type of DES (a stronger impact of diabetes in patients receiving second-generation DES). Conclusions Having diabetes independently increases the risk of adverse events after DES implantation. Interestingly, however, the impact of diabetes varies depending on patient characteristics and the type of PCI performed.
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Molaro et al. (2026) conducted a meta-analysis in Patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) (n=9,699). Diabetes mellitus vs. Nondiabetic status was evaluated on All-cause mortality (HRadj 1.67, 95% CI 1.59-1.77). Diabetes mellitus was associated with higher 10-year all-cause mortality after PCI with DES compared to no diabetes (41.3% vs 26.4%; HRadj 1.67; 95% CI 1.59-1.77).
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