Patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) for left main (LM) bifurcation lesions had significantly worse long-term cardiovascular outcomes than those without diabetes, according to a systematic review and meta-analysis presented at EuroPCR 2026.

The analysis followed PRISMA guidelines and included observational studies and clinical trials identified through searches of PubMed, the Cochrane Library, Web of Science, and Scopus through August 2025. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and definite or probable stent thrombosis. The analysis included six studies comprising 12,494 patients undergoing PCI for LM bifurcation lesions.

Findings

• DM prevalence across the included cohorts ranged from 33% to 50%.
• Patients with DM had a significantly higher risk of MACE between 9 months and 2 years (RR range: 1.73-1.92).
• MI risk remained elevated through mid-to-long-term follow-up, with a nearly two-fold higher risk observed for up to 5 years after PCI (RR range: 1.90-2.16).
• Cardiac mortality at 9 months was significantly higher in patients with DM (RR: 1.96).
• TLR rates were higher in patients with DM between 9 months and 2 years (RR range: 1.61-1.82).
• No statistically significant association was observed between DM status and definite or probable stent thrombosis.

Patients with diabetes remained at higher risk for ischemic events and repeat revascularization after LM bifurcation PCI despite contemporary PCI strategies and drug-eluting stent use. The findings suggest persistent residual cardiovascular risk in this population following complex coronary intervention.