Impact of Diabetes Mellitus in Women Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents Collaborative Patient-Level Pooled Analysis

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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


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.

Original languageEnglish
Article numbere007734
JournalCirculation: Cardiovascular Interventions
Issue number7
Publication statusPublished - 1 Jul 2019


  • Diabetes mellitus
  • Drug-eluting stents (DES)
  • Myocardial infarction
  • Percutaneous Coronary Intervention (PCI)
  • Women
  • n/a OA procedure

Cite this