Evidence for a "gender paradox" in diabetic patients undergoing percutaneous coronary intervention: adverse preprocedural risk but favorable long-term clinical outcome in women.
BACKGROUND
The aim of this study was to assess the impact of gender on procedural and late clinical outcome in a large cohort of consecutive diabetic patients undergoing percutaneous coronary intervention (PCI) in a single center.


METHODS
The study included a cohort of 542 consecutive diabetic patients (414 men, 128 women), undergoing PCI for stable and unstable angina. Clinical events were assessed every 6 months for a mean follow-up period of 24 months.


RESULTS
Compared to men, women were older and less often smokers. Insulin requirement was present in a substantially higher percentage of women than men (27 vs 18%, p = 0.03). Presentation with stable angina was more frequent in women, whereas silent ischemia was more prevalent in men. Adverse baseline clinical and angiographic characteristics in women (smaller vessels and longer lesion lengths) were associated with a more frequent need for multiple coronary stenting (23 vs 15% women vs men, p < 0.001) and a higher incidence of peripheral complications (3.2 vs 1.2%, p = 0.049). However, there were no statistically significant gender-related differences in major in-hospital events. Long-term clinical outcome was similar with equivalent incidence of death (4.9 vs 5.3%, p = 0.8), nonfatal myocardial infarction (2.4 vs 4.5%, p = 0.1), need for surgical or repeat percutaneous revascularization between women and men.


CONCLUSIONS
Diabetic patients show an increased rate of major adverse cardiac events and target vessel revascularization after PCI. In these patients, female gender is associated with higher procedural complexity and peripheral complications; however, long-term clinical outcome of diabetic women is similar to that of men.
Boccuzzi
Giacomo
G
Department of Invasive Cardiology, Istituto Clinico Humanitas, Rozzano (MI), Italy.
Belli
Guido
G
Pagnotta
Paolo
P
Rossi
Marco Luciano
ML
Parenti
Dennis Zavalloni
DZ
Milone
Francesco
F
Aldrovandi
Annachiara
A
Scatturin
Melania
M
Morenghi
Emanuela
E
Presbitero
Patrizia
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017225:Atherectomy, Coronary; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome