Impact of Diabetes on Long-Term Outcomes of Percutaneous Coronary Intervention for Coronary Bifurcation Lesions

Background: Diabetes mellitus (DM) is a well-known risk factor for cardiovascular diseases, including coronary artery diseases (CAD). Complex percutaneous coronary intervention (PCI) such as PCI for bifurcation lesions often yields poor outcomes, especially in DM patients. Aims: The effect of DM on cardiovascular outcomes in bifurcation PCI was investigated in this retrospective, multicenter, observational, real-world registry of 2648 patients with coronary bifurcation lesions undergoing PCI with contemporary drug-eluting stents (DES). Methods: The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction and target lesion revascularization. The adjusted outcomes were compared using 1:1 propensity score (PS) matching. Results: Overall, DM patients were more likely to be older, female, and have hypertension or chronic kidney disease. After PS matching, the cumulative incidence of the primary outcome remained higher in the DM group (7.9% vs. 5.5%, log-rank p = 0.033). In multivariable analysis, DM (HR, 1.57; 95% CI, 1.02−2.43; p = 0.040), chronic kidney disease (HR, 2.62; 95% CI, 1.27−5.38; p = 0.008), low left ventricular ejection fraction (HR, 1.92; 95% CI, 1.10−3.35; p = 0.022) and the two-stent technique (HR, 2.18; 95% CI, 1.17−4.05; p = 0.013) were independent predictors of TLF. For patients with intravascular ultrasound-guided PCI, TLF rates were similar between DM and non-DM groups (9.1% vs. 7.3%, log-rank p = 0.347). Conclusion: For patients with coronary bifurcation lesions undergoing contemporary PCI, 5-year TLF rates were worse in DM patients. Careful planning and usage of imaging devices may help ameliorate outcomes for DM patients.