Abstract
BACKGROUND: Managing coronary artery disease in diabetic patients, especially left main coronary artery (LMCA) disease, requires complex decision-making. Drug-eluting stents, such as the Resolute zotarolimus-eluting stent (ZES), provide a less invasive alternative to coronary artery bypass grafting for revascularisation. AIMS: We aimed to compare the mortality rates between patients with or without diabetes following left main percutaneous coronary intervention (PCI) using the Resolute ZES and to assess the major predictors of cardiac death based on baseline characteristics, lesion features, and procedural details. METHODS: This retrospective cohort study conducted between 2010 and 2019 at a tertiary care cardiac hospital in Bangladesh involved 884 patients undergoing left main PCI with the Resolute ZES. The primary endpoint of this study was the difference in mortality between the two groups (diabetes vs non-diabetes). Descriptive and inferential statistics were used to analyse patient demographics, clinical characteristics, and outcomes. Survival analyses utilised Kaplan-Meier curves and Cox proportional hazards models for both univariate and multivariate analyses. RESULTS: All-cause mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.47-1.61; p=0.67) and cardiac death rates (HR 0.84, 95% CI: 0.43-1.65; p=0.61) were similar for the diabetes and non-diabetes groups, and the predictors of cardiac death in the multivariate analysis included age (HR 1.09, 95% CI: 1.06-1.13; p<0.001), elevated creatinine levels (HR 4.45, 95% CI: 1.80-11.02; p<0.001), and post-dilatation (HR 0.10, 95% CI: 0.03-0.39; p<0.001); the Medina classification also showed a significant association with cardiac death. CONCLUSIONS: The use of the Resolute ZES was associated with comparable outcomes in diabetic and non-diabetic patients undergoing left main PCI. Age, renal function, and certain procedural techniques are key predictors of cardiac death, emphasising the need for individualised patient assessment in LMCA disease management.