Comparison of percutaneous coronary intervention outcomes in diabetic patients with non-ST-elevation myocardial infarction having multivessel disease

Background: Diabetic patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel coronary artery disease (MVD) present unique challenges in revascularization strategy selection. This study compares the clinical outcomes of multivessel (MVR) versus single-vessel revascularization (SVR) using percutaneous coronary intervention (PCI) in such patients. Methods: A prospective observational study was conducted at a tertiary center in Bangladesh including 110 diabetic NSTEMI patients with angiographically confirmed MVD. Patients underwent either MVR (n=58) or SVR (n=52). Outcomes assessed over a 6-month follow-up included major adverse cardiovascular and cerebrovascular events (MACCE), left ventricular ejection fraction (LVEF), functional capacity (METS), and survival. Results: Baseline characteristics were comparable between groups. The MVR group had significantly more stents (2.36±0.49 vs. 1.17±0.38; p<0.01) and longer stent length (58.76±10.22 mm vs. 33.46±10.93 mm; p<0.01). MACCE was significantly lower in the MVR group (6.89% vs. 30.77%; p=0.001), with reduced myocardial infarction and revascularization rates. Both groups showed significant improvement in LVEF and METS post-PCI, with no significant intergroup difference. Kaplan–Meier analysis revealed superior event-free survival in the MVR group. Conclusions: Multivessel PCI offers superior clinical outcomes and event-free survival in diabetic NSTEMI patients with MVD, without increasing periprocedural risks. Individualized risk-benefit assessment remains essential.