BACKGROUND:

While overall mortality in cardiovascular disease has declined, some groups such as females with diabetes are still at increased risk for worse outcome after ACS. We aimed to compare 1-year outcomes between female and male ACS patients after PCI stratified by the presence of diabetes mellitus (DM).

METHODS:

PROMETHEUS was a multicenter observational study of patients undergoing PCI for ACS discharged on clopidogrel or prasugrel (n= 19914; 38.1% DM). Endpoints included major adverse cardiovascular events (MACE) defined as death, myocardial infarction (MI), stroke and unplanned revascularization. Outcomes at 1 year were adjusted using multivariable Cox regression modeling.

RESULTS:

Overall, women were older, with more hypertension, chronic kidney disease and heart failure, but less previous MI and revascularization. Furthermore, rates of multivessel and complex disease were lower in women than men in DM and non-DM groups. At 1 year, rates of death, MI, and MACE were significantly higher in women compared to men regardless of the presence of diabetes. After adjustment, DM was an independent risk factor for death, revascularization and MACE in both female and male ACS patients after PCI. However, compared with their non-diabetic counterparts, diabetic women had a higher adjusted mortality risk than diabetic men (pint=0.021; Figure ).

CONCLUSION:

DM was an independent risk factor for death, revascularization and MACE in both female and male ACS patients after PCI. However, the adjusted mortality risk associated with diabetes was higher for female than for male ACS patients.