Sex-associated differences in clinical outcomes after coronary stenting in patients with diabetes mellitus.
OBJECTIVE
It has been suggested that the influence of diabetes on cardiovascular mortality is sex dependent. We undertook this study to determine whether there were sex-related differences in 1-year clinical outcomes following coronary artery stenting in diabetic patients.


METHODS
The study included 4460 consecutive patients (1084 women) who underwent coronary artery stenting for stable or unstable angina, of whom 970 (22%) had diabetes. Six-month follow-up angiography was performed in 3452 patients (77.4%). The primary endpoint was the combined incidence of major adverse cardiac events (death, myocardial infarction, and target vessel revascularization).


RESULTS
Diabetes was associated with a significant increase in the combined incidence of death, myocardial infarction, and target vessel revascularization at 1 year in women; this incidence was greater in diabetic women than in nondiabetic women (26.9% [84/312] vs. 18.9% [146/772]; odds ratio [OR] = 1.5; 95% confidence interval [CI]: 1.2 to 2.0; P = 0.002). The primary endpoint appeared to be similar in men regardless of diabetes status (24.6% [162/658] with diabetes vs. 23.3% [634/2718] without diabetes; OR = 1.07; 95% CI: 0.90 to 1.27; P = 0.43). There was a significant interaction between diabetes and sex in both unadjusted (P = 0.03) and adjusted (P = 0.04) analyses, with diabetes having a greater negative effect in women than in men for major adverse cardiac events after coronary stenting.


CONCLUSIONS
In patients who underwent coronary artery stenting, the increased risk of adverse cardiac events associated with diabetes was more pronounced in women than in men.
Ndrepepa
Gjin
G
Deutsches Herzzentrum, 80636 Munich, Germany. ndrepepa@dhm.mhn.de
Mehilli
Julinda
J
Bollwein
Hildegard
H
Pache
Jürgen
J
Schömig
Albert
A
Kastrati
Adnan
A
D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D017023:Coronary Angiography; D003331:Coronary Vessels; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome