A LARGE multinational study has revealed that patients with diabetes mellitus (DM) face significantly worse long-term outcomes following percutaneous coronary intervention (PCI) for coronary bifurcation lesions, with target lesion failure rates nearly 50% higher than non-diabetic patients, though intravascular ultrasound (IVUS) guidance may mitigate this risk.
Diabetes mellitus is a well-established risk factor for adverse cardiovascular outcomes, particularly in complex interventions such as bifurcation PCI. Despite advances in drug-eluting stents (DES) and procedural techniques, diabetic patients continue to experience higher rates of complications. This retrospective analysis of 2,648 patients from the COBIS III registry compared five-year outcomes between diabetic and non-diabetic cohorts undergoing contemporary bifurcation PCI, providing critical insights for optimising management in this high-risk population.
The study included patients treated with second-generation DES across multiple centres, using propensity score matching to balance baseline characteristics. Diabetic patients (n=1,324) were older (mean 65.3 vs 63.1 years), more likely female (32.8% vs 27.1%), and had higher rates of hypertension (76.4% vs 62.3%) and chronic kidney disease (12.1% vs 6.8%). At five years, diabetic patients demonstrated significantly higher target lesion failure (TLF) rates (7.9% vs 5.5%, HR 1.57; 95% CI 1.02–2.43; p=0.040), driven by increased target lesion revascularisation (5.1% vs 3.2%). Major adverse cardiovascular events (MACE) showed no significant difference after adjustment (10.3% vs 8.9%, p=0.214). Notably, IVUS-guided PCI eliminated outcome disparities, with comparable TLF rates between diabetic and non-diabetic groups (9.1% vs 7.3%, p=0.347). Independent predictors of TLF included DM (HR 1.57), chronic kidney disease (HR 2.62), left ventricular ejection fraction <50% (HR 1.92), and two-stent techniques (HR 2.18). Mortality analysis revealed diabetic patients had 66% higher adjusted mortality risk (HR 1.66; 95% CI 1.33–1.72), particularly pronounced in younger patients (<65 years: HR 2.12).
These findings highlight the need for meticulous procedural planning in diabetic patients undergoing bifurcation PCI. For clinical practice, routine IVUS utilisation and preferential use of single-stent strategies could substantially improve outcomes. Future research should investigate optimal antiplatelet regimens and glycaemic control targets specific to post-PCI diabetic populations. The results advocate for enhanced secondary prevention protocols and systematic intracoronary imaging adoption to address diabetes-associated vascular vulnerabilities.
Katrina Thornber, EMJ
Reference
Lim S et al. Impact of diabetes on long‐term outcomes of percutaneous coronary intervention for coronary bifurcation lesions. Catheterization and Cardiovascular Interventions. 2025. DOI:10.1002/ccd.31476.
