title: Evidence for a "gender paradox" in diabetic patients undergoing percutaneous coronary intervention: adverse preprocedural risk but favorable long-term clinical outcome in women.
abstract: 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.
authors.affiliation: Department of Invasive Cardiology, Istituto Clinico Humanitas, Rozzano (MI), Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Boccuzzi
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.forename: Dennis Zavalloni
authors.initials: DZ
authors.lastname: Parenti
authors.forename: Francesco
authors.initials: F
authors.lastname: Milone
authors.forename: Annachiara
authors.initials: A
authors.lastname: Aldrovandi
authors.forename: Melania
authors.initials: M
authors.lastname: Scatturin
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
mesh_terms: 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