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

Usman Baber; Giulio G Stefanini; Gennaro Giustino; Gregg W Stone; Martin B Leon; Samantha Sartori; Melissa Aquino; P Gabriel Steg; Stephan Windecker; William Wijns; Patrick W Serruys; Marco Valgimigli; Marie-Claude Morice; Edoardo Camenzind; Giora Weisz; Pieter C Smits; David E Kandzari; Clemens von Birgelen; George D Dangas; Soren Galatius; Raban V Jeger; Takeshi Kimura; Ghada W Mikhail; Dipti Itchhaporia; Laxmi Mehta; Rebecca Ortega; Hyo-Soo Kim; Adnan Kastrati; Alaide Chieffo; Roxana Mehran

doi:10.1161/CIRCINTERVENTIONS.118.007734

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

Usman Baber, Giulio G Stefanini, Gennaro Giustino, Gregg W Stone, Martin B Leon, Samantha Sartori, Melissa Aquino, P Gabriel Steg, Stephan Windecker, William Wijns, Patrick W Serruys, Marco Valgimigli, Marie-Claude Morice, Edoardo Camenzind, Giora Weisz, Pieter C Smits, David E Kandzari, Clemens von Birgelen, George D Dangas, Soren GalatiusRaban V Jeger, Takeshi Kimura, Ghada W Mikhail, Dipti Itchhaporia, Laxmi Mehta, Rebecca Ortega, Hyo-Soo Kim, Adnan Kastrati, Alaide Chieffo, Roxana Mehran

Hjerteafd. Y

Abstract

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.

Originalsprog	Engelsk
Tidsskrift	Circulation. Cardiovascular interventions
Vol/bind	12
Udgave nummer	7
ISSN	1941-7640
DOI	https://doi.org/10.1161/CIRCINTERVENTIONS.118.007734
Status	Udgivet - jul. 2019

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10.1161/CIRCINTERVENTIONS.118.007734

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Baber, U., Stefanini, G. G., Giustino, G., Stone, G. W., Leon, M. B., Sartori, S., Aquino, M., Steg, P. G., Windecker, S., Wijns, W., Serruys, P. W., Valgimigli, M., Morice, M.-C., Camenzind, E., Weisz, G., Smits, P. C., Kandzari, D. E., von Birgelen, C., Dangas, G. D., ... Mehran, R. (2019). Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents. Circulation. Cardiovascular interventions, 12(7). https://doi.org/10.1161/CIRCINTERVENTIONS.118.007734

Baber, U, Stefanini, GG, Giustino, G, Stone, GW, Leon, MB, Sartori, S, Aquino, M, Steg, PG, Windecker, S, Wijns, W, Serruys, PW, Valgimigli, M, Morice, M-C, Camenzind, E, Weisz, G, Smits, PC, Kandzari, DE, von Birgelen, C, Dangas, GD, Galatius, S, Jeger, RV, Kimura, T, Mikhail, GW, Itchhaporia, D, Mehta, L, Ortega, R, Kim, H-S, Kastrati, A, Chieffo, A & Mehran, R 2019, 'Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents', Circulation. Cardiovascular interventions, bind 12, nr. 7. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007734

@article{0b3b9745f06549b7b7152469e7ceabe6,

title = "Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents",

abstract = "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.",

author = "Usman Baber and Stefanini, {Giulio G} and Gennaro Giustino and Stone, {Gregg W} and Leon, {Martin B} and Samantha Sartori and Melissa Aquino and Steg, {P Gabriel} and Stephan Windecker and William Wijns and Serruys, {Patrick W} and Marco Valgimigli and Marie-Claude Morice and Edoardo Camenzind and Giora Weisz and Smits, {Pieter C} and Kandzari, {David E} and {von Birgelen}, Clemens and Dangas, {George D} and Soren Galatius and Jeger, {Raban V} and Takeshi Kimura and Mikhail, {Ghada W} and Dipti Itchhaporia and Laxmi Mehta and Rebecca Ortega and Hyo-Soo Kim and Adnan Kastrati and Alaide Chieffo and Roxana Mehran",

year = "2019",

month = jul,

doi = "10.1161/CIRCINTERVENTIONS.118.007734",

language = "English",

volume = "12",

journal = "Circulation. Cardiovascular interventions",

issn = "1941-7640",

publisher = "Lippincott Williams & Wilkins",

number = "7",

}

TY - JOUR

T1 - Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

AU - Baber, Usman

AU - Stefanini, Giulio G

AU - Giustino, Gennaro

AU - Stone, Gregg W

AU - Leon, Martin B

AU - Sartori, Samantha

AU - Aquino, Melissa

AU - Steg, P Gabriel

AU - Windecker, Stephan

AU - Wijns, William

AU - Serruys, Patrick W

AU - Valgimigli, Marco

AU - Morice, Marie-Claude

AU - Camenzind, Edoardo

AU - Weisz, Giora

AU - Smits, Pieter C

AU - Kandzari, David E

AU - von Birgelen, Clemens

AU - Dangas, George D

AU - Galatius, Soren

AU - Jeger, Raban V

AU - Kimura, Takeshi

AU - Mikhail, Ghada W

AU - Itchhaporia, Dipti

AU - Mehta, Laxmi

AU - Ortega, Rebecca

AU - Kim, Hyo-Soo

AU - Kastrati, Adnan

AU - Chieffo, Alaide

AU - Mehran, Roxana

PY - 2019/7

Y1 - 2019/7

N2 - 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.

AB - 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.

U2 - 10.1161/CIRCINTERVENTIONS.118.007734

DO - 10.1161/CIRCINTERVENTIONS.118.007734

M3 - Journal article

C2 - 31288561

SN - 1941-7640

VL - 12

JO - Circulation. Cardiovascular interventions

JF - Circulation. Cardiovascular interventions

IS - 7

ER -

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

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