Impact of diabetes mellitus on bifurcation percutaneous coronary intervention: Insights from the PROGRESS-BIFURCATION registry

Abstract

Background:The impact of diabetes mellitus (DM) on short and long-term outcomes following bifurcation percutaneous coronary intervention (PCI) has received limited study.Methods:We examined the procedural characteristics and outcomes of 1,224 bifurcation PCIs (1,076 patients) performed at five centers between 2013-2024 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION, NCT05100992).Results:Diabetes mellitus was present in 394 patients (34.20%). Patients with diabetes were more likely to be female (32.30% vs 21.50%, P <0.001), have greater body mass index (BMI) (32.56 ± 6.38 vs 29.26 ± 5.87, P < 0.001) and more comorbidities such as hypertension, dyslipidemia and heart failure. Diabetic patients had more complex angiographic characteristics, with higher prevalence of left main (LM), proximal left anterior descending and right coronary artery stenoses. The main vessel was more likely to be the LM or the right coronary artery in patients with diabetes. Diabetic patients had lower rates of provisional stenting (64.30% vs 70.40%, P = 0.029), required higher procedure times (89.75 min vs 77.00 min, P = 0.001) and radiation (1.57 Gy vs 1.31 Gy, P = 0.002), and were more likely to need in-hospital repeat PCI (OR: 2.8 CI: 1.07, 7.76, P = 0.039). Diabetes was independently associated with higher MACE during follow-up (HR: 1.94, CI: 1.36, 2.76, P < 0.001). Follow-up MI (HR: 2.32 CI: 1.37, 3.94, P = 0.013) and death (HR: 2.56 CI: 1.51, 4.35, P < 0.001) were higher in diabetic patients after adjusting for confounders.Conclusions:Bifurcation PCI in patients with diabetes mellitus was associated with higher risk of in-hospital repeat-PCI, follow-up MI and death compared with non-diabetic patients.