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Introduction <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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. </p>

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Impact of Diabetes on Long-Term Outcomes After Percutaneous Intervention for Coronary Bifurcation Lesions: A Systematic Review and Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Ricardo F.O Suruagy-Motta,
  • Bruno Marçola Ishizuka,
  • Victor Arthur Ohannesian,
  • Júlia Agra Silva,
  • Diego Rajchenberg,
  • Viviane de Oliveira Dantas,
  • Eduarda Lima Ornelas Pinto,
  • Nathália Pires Abeyá,
  • Evandro Martins Filho,
  • Lorenzo Azzalini,
  • Sant Kumar

摘要

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.