Gender-Based Outcomes Among Patients With Diabetes Mellitus After Percutaneous Coronary Intervention in the Drug-Eluting Stent Era

Abstract

SummaryDiabetes mellitus has a greater effect on mortality rates due to coronary artery disease in women than in men. Although women undergoing coronary intervention in general have a higher frequency of adverse outcomes than men, the effect of gender among diabetic patients on clinical outcomes after percutaneous coronary intervention (PCI) has not been well established in the drug-eluting stent (DES) era. We have investigated the impact of gender on long-term clinical outcome in these high risk populations. We enrolled 404 consecutive patients (74 women and 330 men) with diabetes mellitus who underwent elective PCI (85% with DES). We evaluated the incidence of major adverse cardiac events (MACE), which is a composite of total all-cause death, acute coronary syndrome (ACS), and target lesion revascularization (TLR) during a period of 4 years after coronary intervention. The women were significantly older, more likely to have dyslipidemia, and had significantly higher systolic blood pressure and LDL-C values than men. The use of insulin and angiotensin receptor blockers was more frequent among the women (32.4% versus 21.0%, P = 0.04 and 60.8% versus 39.8%, P < 0.01, respectively). The angiographic profiles of both were comparable. At four-year clinical follow-up, cumulative incidence of MACE was identical between the women and the men (16.2% versus 15.5%, P = 0.90; adjusted HR 1.23, 95% CI 0.61-2.50, P = 0.56). Although the baseline characteristics of the women were worse, clinical outcomes did not significantly differ between women and men among diabetic patients after elective PCI. (Int Heart J 2011; 52: 348-352) Key words: Gender, Diabetes mellitus, Cardiovascular disease, Coronary intervention, Drug-eluting stent P atients with diabetes mellitus (DM) have a higher incidence of cardiovascular disease (CVD) than the general population. 1,2) Diabetes has a greater effect on coronary artery disease (CAD) mortality rates among women than men. [3][4][5] Previous studies have demonstrated that diabetes mellitus is associated with accelerated development of atherosclerosis characterized by small vessels, long lesions, and a greater plaque burden. These findings have been attributed to worse outcomes after percutaneous coronary intervention (PCI) among patients with DM.6-8) Drug-eluting stents (DES) have remarkably reduced the incidence of restenosis compared with bare-metal stents (BMS) in randomized trials 9,10) and several studies have found a favorable clinical outcome of DES for patients with DM. 11,12) Gender differences were associated with presenting symptoms, method of diagnosis, baseline comorbidities, and outcomes of patients in the early period of balloon angioplasty. 13,14) Gender-based differences in outcomes after PCI narrowed after introduction of the BMS as well as DES, 15,16) and gender was not independently associated with adverse outcomes especially in low risk populations. However, gender differences among diabetic patients after PCI in the period of DES have not been fully elucidated. Therefore,...

Sex differences in long-term outcomes of patients with percutaneous coronary intervention: the Armenian experience

“…In contrast, a recent study that enrolled only patients with diabetes in Japan found that at 4-year follow-up after PCI, the cumulative incidence of MACE was similar between the sexes, despite the fact that women had a worse baseline profile. 20 Similar to our study, a significant interaction was observed by Mehilli et al, who evaluated the impact of sex on mortality after PCI in a cohort of patients with stable and unstable angina. 12 They reported that diabetic women had almost twice the mortality hazard in comparison to diabetic men, whereas no significant difference was observed in mortality among the non-diabetic population.…”

Impact of gender difference on PCI outcome in Egyptian diabetic patients: Prospective two center registry study

“…Our results and the results reported by Ogita et al, 7 Shrestha et al, 17 Buja et al, 18 Stefanini et al, 19 Funakoshi et al, 20 Kralev et al, 21 and Lansky et al 22 suggest that DES have leveled the playing field between diabetic males and females undergoing PCI. The acute angiographic success and clinical outcomes are similar between males and females, despite advanced age and more co-morbidities in the latter.…”

“…Funakoshi et al 20 reported no significant gender difference in the incidence of MACEs at a 3-year follow up period of the Japanese CREDO-Koyato registry; the rate of all cause death and ACS among women in that registry was 4.3% and 8.4%, respectively. Ogita et al 7 showed no significance difference in the PCI outcome among men and women after elective drugeluting stent implantation in diabetic patients. Kralev et al 21 reported that female gender did not emerge as an independent predictor of MACEs despite the worse baseline clinical features seen in females.…”

MECHANISMS IN ENDOCRINOLOGY: Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men?

“…A few studies, such as the large Asia Pacific Cohort Studies Collaboration (2), did not show any difference between sexes in deaths from CHD, cerebrovascular disease or other CVDs, irrespective of ethnicity. Moreover, although these studies have considered the risk of CVD events in those initially free of CVD, some authors found no sex difference according to DM in risk of recurrent CVD in women and men with existing CVD (8).…”