Diabetes Linked to Worse Outcomes After Left Main Bifurcation PCI: Meta-Analysis
Brazil: Diabetes mellitus (DM) is associated with significantly worse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for left main (LM) coronary bifurcation lesions, according to a systematic review and meta-analysis presented at EuroPCR 2026. The analysis found that diabetic patients faced higher risks of major adverse cardiovascular events (MACE), myocardial infarction, cardiac death, and repeat revascularization despite advances in drug-eluting stents and contemporary PCI techniques.
The study, presented by Julia Franco of PUC-PR, State of Paraná, Brazil, and colleagues, examined the impact of diabetes mellitus on outcomes following PCI for left main (LM) bifurcation lesions, a particularly complex form of coronary artery disease.
Researchers conducted a systematic review and meta-analysis following PRISMA guidelines, with the protocol prospectively registered in the PROSPERO database. Relevant studies published through August 2025 were identified through searches of PubMed, Cochrane Library, Web of Science, and Scopus.
The final analysis included six studies involving 12,494 patients who underwent PCI for LM bifurcation lesions. Diabetes was common across the study populations, affecting between 33% and 50% of patients.
The primary endpoint was major adverse cardiovascular events (MACE), while secondary endpoints included all-cause mortality, cardiac death, myocardial infarction, and target lesion revascularization. Outcomes were analyzed using a random-effects model across follow-up periods ranging from 9 months to 5 years.
Key Findings:
- Diabetes mellitus was a significant predictor of adverse cardiovascular outcomes following PCI for left main bifurcation lesions.
- Patients with diabetes had a 1.73- to 1.92-fold higher risk of MACE between 9 months and 2 years after PCI compared with non-diabetic patients.
- The risk of myocardial infarction remained significantly elevated in diabetic patients throughout follow-up.
- Diabetic patients experienced nearly twice the risk of myocardial infarction for up to 5 years after PCI.
- Diabetes was associated with a higher risk of cardiac death at 9 months following the procedure.
- Patients with diabetes had a 1.61- to 1.82-fold greater risk of requiring target lesion revascularization between 9 months and 2 years after PCI.
- No significant association was observed between diabetes status and the risk of definite or probable stent thrombosis.
- The excess cardiovascular risk associated with diabetes appeared to be driven by progressive coronary artery disease and recurrent ischemic events rather than stent-related complications.
The researchers concluded that diabetes remains a robust independent predictor of poor long-term outcomes after PCI for LM bifurcation lesions, even in the era of modern drug-eluting stents and optimized procedural techniques. They emphasized the need for intensive secondary prevention strategies, better glycemic control, and potentially more individualized interventional approaches, including greater use of intravascular imaging, to reduce the elevated ischemic risk in this vulnerable patient population.
Reference:
Franco J, et al. Impact of Diabetes Mellitus on Outcomes of Bifurcation PCI: A Systematic Review and Meta-Analysis. Abstract A100127RS. Presented at EuroPCR 2026; Paris, France.
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