Impact of diabetes on long-term outcomes of bifurcation percutaneous coronary intervention. An analysis from the BIFURCAT registry

Abstract

Background: It is still unclear the impact of diabetes mellitus (DM) in complex coronary lesions treated with percutaneous coronary intervention (PCI) which themselves are at increased incidence of adverse events. Methods: BIFURCAT registry encompassed patients treated with PCI for coronary bifurcation lesion from the COBIS III and the RAIN registry. The primary endpoint was the occurrence of major cardiovascular adverse event (MACE), a composite and mutual exclusive of all-cause death or myocardial infarction (MI) or target-lesion revascularization (TLR). A total of 5537 patients were included in the analysis and 1834 (33%) suffered from DM. Results: After a median follow-up of 21 months, diabetic patients had a higher incidence of MACE (17% vs. 9%, p < 0.001), all-cause mortality (9% vs. 4%, p < 0.001), TLR (5% vs. 3%, p = 0.001), MI (4% vs. 2%, p < 0.001), and stent thrombosis (ST) (2% vs. 1%, p = 0.007). After multivariate analysis, diabetes remained significantly associated with MACE (hazard ratio [HR]: 1.37; confidence interval [CI]: 1.13–1.65; p = 0.001), all-cause death (HR: 1.65; 95% CI: 1.24–2.19, p = 0.001), TLR (HR: 1.45; CI: 1.03–2.04; p = 0.031) and ST (HR: 1.73, CI: 1.04–2.88; p = 0.036), but not with MI (HR: 1.34; CI: 0.93–1.92; p = 0.11). Among diabetics, chronic kidney disease (HR: 2.99; CI: 2.21–4.04), baseline left ventricular ejection fraction (HR: 0.98; CI: 0.97–0.99), femoral access (HR: 1.62; CI: 1.23–2.15), left main coronary artery (HR: 1.44; CI: 1.06–1.94), main branch diameter (HR: 0.79; CI: 0.66–0.94) and final kissing balloon (HR: 0.70; CI: 0.52–0.93) were independent predictors of MACE at follow-up. Conclusions: Patients with DM treated with PCI for coronary bifurcations have a worse prognosis due to higher incidence of MACE, all-cause mortality, TLR and ST compared to the non-diabetics.