Patients with diabetes presenting with STEMI and multivessel disease (MVD) face higher cardiovascular risk, yet the optimal PCI strategy remains uncertain. A sub analysis of the MULTISTARS AMI trial, which enrolled 840 patients, included 131 (15.6%) with diabetes.

Patients with diabetes had a higher risk profile and worse kidney function than those without diabetes. At one year, the composite endpoint of death, myocardial infarction, stroke, unplanned revascularization, or heart failure hospitalization was similar between groups (HR 1.14, 95% CI 0.69–1.90; p=0.60). However, rates of non-cardiovascular death (HR 6.53, 95% CI 2.00–21.33) and acute renal failure (HR 3.23, 95% CI 1.49–7.04) were higher in patients with diabetes.

Within this subgroup, immediate multivessel PCI was associated with fewer primary endpoint events than staged PCI (10.6% vs 16.9%; HR 0.60, 95% CI 0.23–1.53; p=0.28), though not statistically significant. These findings suggest immediate PCI may be a safe strategy, warranting confirmation in larger studies.