title: Sex-specific outcomes of diabetic patients with acute myocardial infarction who have undergone percutaneous coronary intervention: a register linkage study.
abstract: BACKGROUND
  The presence of diabetes mellitus poses a challenge in the treatment of patients with acute myocardial infarction (AMI). We aimed to evaluate the sex-specific outcomes of diabetic and non-diabetic patients with AMI who have undergone percutaneous coronary intervention (PCI).
  
  
  METHODS
  Data of the Estonian Myocardial Infarction Registry for years 2006-2009 were linked with the Health Insurance Fund database and the Population Registry. Hazard ratios (HRs) with the 95% confidence intervals (CIs) for the primary composite outcome (non-fatal AMI, revascularization, or death whichever occurred first) and for the secondary outcome (all cause mortality) were calculated comparing diabetic with non-diabetic patients by sex.
  
  
  RESULTS
  In the final study population (n=1652), 14.6% of the men and 24.0% of the women had diabetes. Overall, the diabetics had higher rates of cardiovascular risk factors, co-morbidities, and 3-4 vessel disease among both men and women (p<0.01). Among women, the diabetic patients were younger, they presented later and less often with typical symptoms of chest pain than the non-diabetics (p<0.01). Women with diabetes received aspirin and reperfusion for ST-segment elevation AMI less often than those without diabetes (p<0.01). During a follow-up of over two years, in multivariate analysis, diabetes was associated with worse outcomes only in women: the adjusted HR for the primary outcome 1.44 (95% CI 1.05-1.96) and for the secondary outcome 1.83 (95% CI 1.17-2.89). These results were largely driven by a high (12.0%) mortality during hospitalization of diabetic women.
  
  
  CONCLUSIONS
  Diabetic women with AMI who have undergone PCI are a high-risk group warranting special attention in treatment strategies, especially during hospitalization. There is a need to improve the expertise to detect AMI earlier, decrease disparities in management, and find targeted PCI strategies with adjunctive antithrombotic regimes in women with diabetes.
authors.affiliation: Department of Cardiology, University of Tartu, 8 L, Puusepa Street, Tartu, 51014, Estonia. mai.blondal@kliinikum.ee
authors.forename: Mai
authors.initials: M
authors.lastname: Blöndal
authors.forename: Tiia
authors.initials: T
authors.lastname: Ainla
authors.forename: Toomas
authors.initials: T
authors.lastname: Marandi
authors.forename: Aleksei
authors.initials: A
authors.lastname: Baburin
authors.forename: Jaan
authors.initials: J
authors.lastname: Eha
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents