Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.

Baber, Usman; Stefanini, Giulio G; Giustino, Gennaro; Stone, Gregg W; Leon, Martin B; Sartori, Samantha; Aquino, Melissa; Steg, P Gabriel; Windecker, Stephan; Wijns, William; Serruys, Patrick W; Valgimigli, Marco; Morice, Marie-Claude; Camenzind, Edoardo; Weisz, Giora; Smits, Pieter C; Kandzari, David E; von Birgelen, Clemens; Dangas, George D; Galatius, Soren; ... (2019). Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents. Circulation: Cardiovascular interventions, 12(7), e007734. Lippincott Williams & Wilkins 10.1161/CIRCINTERVENTIONS.118.007734

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BACKGROUND Data examining the impact of diabetes mellitus (DM) on ischemic risk after percutaneous coronary intervention in women are limited as most clinical trial participants are male. We evaluated (1) the impact of DM on ischemic outcomes in women undergoing drug-eluting stent (DES) implantation and (2) whether the outcomes of new- versus early-generation DES vary by DM status. METHODS AND RESULTS We pooled patient-level data of 10 448 women undergoing percutaneous coronary intervention with DES from 26 randomized trials. Baseline characteristics and 3-year clinical outcomes were stratified according to DM status (noninsulin-dependent and insulin-dependent) and DES generation. The primary end point was the composite of all-cause death or myocardial infarction. Secondary end points were definite or probable stent thrombosis and target lesion revascularization. Compared with women without DM (n=7154, 68.5%), adjusted risks (adjusted hazard ratios [95% CI]) for death or myocardial infarction among women with noninsulin-dependent DM (n=2241, 21.4%) and insulin-dependent DM (n=1053, 10.1%) were 1.30 (1.11-1.53) and 1.71 (1.41-2.07), respectively ( Ptrend<0.001). Similar trends were observed for def/prob stent thrombosis and target lesion revascularization. Compared with early-generation DES, use of newer-generation DES was associated with significant reductions in death or myocardial infarction in the absence of DM whereas differences were nonsignificant in the presence of DM, with similar findings for def/prob stent thrombosis and target lesion revascularization. CONCLUSIONS The presence of DM is associated with substantial, graded, and durable risks for ischemic events among women undergoing percutaneous coronary intervention with DES. The safety and efficacy profile of newer-generation DES is preserved among women without DM, while benefits are nonsignificant among women with DM.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1941-7632

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Amanda Valle

Date Deposited:

30 Aug 2019 15:05

Last Modified:

25 Oct 2019 09:23

Publisher DOI:

10.1161/CIRCINTERVENTIONS.118.007734

PubMed ID:

31288561

Uncontrolled Keywords:

diabetes mellitus drug-eluting stents myocardial infarction percutaneous coronary intervention women

BORIS DOI:

10.7892/boris.132772

URI:

https://boris.unibe.ch/id/eprint/132772

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