Sex-specific effects of diabetes on adverse outcomes after percuta neous coronary intervention: Trends over time

Background Diabetes is a stronger risk factor for coronary heart disease in women than in men. Whether diabetes also poses greater risks to women after percutaneous coronary intervention (PCI) has not been examined. Methods We examined 20586 PCI procedures at Emory University Hospitals (Atlanta, GA) between 1990 and 2003. Hazard ratios (HRs) for 1-year major adverse cardiac events were calculated comparing diabetic with nondiabetic patients by sex and study year. Data were adjusted for demographic and clinical factors using Cox proportional hazards models. Results Despite increasing patient age and comorbidity burden, diabetic and nondiabetic men had a significant improvement in PCI outcomes between 1990 and 2003 (P < .001). Diabetic women also tended to have improved PCI outcomes over time (P = .073), but not nondiabetic women (P = .206). Overall, diabetes had a stronger association with adverse outcomes in women (HR 1.93, 95% CI 1.55-2.40) than in men (HR 1.26, 95% CI 1.09-1.47) (P = .002 for the interaction between sex and diabetes). The excess risk associated with diabetes in women, however, was largely driven by early study years (1990-1993). This excess risk associated with diabetes in women declined over time, and diabetes had a similar effect on outcomes in both women and men in more recent years (P = .010 for the interaction between sex, diabetes, and time). Conclusions Percutaneous coronary intervention outcomes of diabetic and nondiabetic men have improved in recent years. However, among women, diabetic patients had greater improvements in outcomes after PCI compared with nondiabetic patients. As a result, diabetes is no longer a stronger risk factor for adverse outcomes after PCI in women than in men.