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Sex-associated differences in clinical outcomes after coronary stenting in patients with diabetes mellitus.

Ndrepepa G, Mehilli J, Bollwein H, Pache J, Schömig A, Kastrati A

Deutsches Herzzentrum, 80636 Munich, Germany. ndrepepa@dhm.mhn.de

PURPOSE: 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. CONCLUSION: 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.

Published 13 December 2004 in Am J Med, 117(11): 830-6.
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