Impact of chronic kidney disease and diabetes on clinical outcomes in women undergoing PCI

Alessandro Spirito, Dipti Itchhaporia, Samantha Sartori, Edoardo Camenzind, Alaide Chieffo, George D. Dangas, Soren Galatius, Raban V. Jeger, David E. Kandzari, Adnan Kastrati, Hyo Soo Kim, Takeshi Kimura, Martin B. Leon, Laxmi S. Mehta, Ghada W. Mikhail, Marie Claude Morice, Johny Nicolas, Brunna Pileggi, Patrick W. Serruys, Pieter C. SmitsP. Gabriel Steg, Gregg W. Stone, Marco Valgimigli, Birgit Vogel, Clemens von Birgelen, Giora Weisz, William Wijns, Stephan Windecker, Roxana Mehran

Research output: Contribution to journalArticlepeer-review


Background: For women undergoing drug-eluting stent (DES) implantation, the individual and combined impact of chronic kidney disease (CKD) and diabetes mellitus (DM) on outcomes is uncertain. Aims: We sought to assess the impact of CKD and DM on prognosis in women after DES implantation. Methods: We pooled patient-level data on women from 26 randomised controlled trials comparing stent types. Women receiving DES were stratified into 4 groups based on CKD (defined as creatine clearance <60 mL/min) and DM status. The primary outcome at 3 years after percutaneous coronary intervention was the composite of all-cause death or myocardial infarction (MI); secondary outcomes included cardiac death, stent thrombosis and target lesion revascularisation. Results: Among 4, 269 women, 1, 822 (42.7%) had no CKD/DM, 978 (22.9%) had CKD alone, 981 (23.0%) had DM alone, and 488 (11.4%) had both conditions. The risk of all-cause death or MI was not increased in women with CKD alone (adjusted hazard ratio [adj. HR] 1.19, 95% confidence interval [CI]: 0.88-1.61) nor DM alone (adj. HR 1.27, 95% CI: 0.94-1.70), but was significantly higher in women with both conditions (adj. HR 2.64, 95% CI: 1.95-3.56; interaction p-value <0.001). CKD and DM in combination were associated with an increased risk of all secondary outcomes, whereas alone, each condition was only associated with all-cause death and cardiac death. Conclusions: Among women receiving DES, the combined presence of CKD and DM was associated with a higher risk of the composite of death or MI and of any secondary outcome, whereas alone, each condition was associated with an increase in all-cause and cardiac death.

Original languageEnglish
Pages (from-to)493-501
Number of pages9
Issue number6
StatePublished - 2023


  • death
  • diabetes
  • drug-eluting stent
  • miscellaneous
  • renal insufficiency


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