Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction
| Autor: | Eun-Ho Choo, Doo-Soo Jeon, Byung-Hee Hwang, Sung-Ho Her, Jongmin Lee, Jeong-Eun Yi, Ik Jun Choi, Dong-Bin Kim, Mahn-Won Park, Myung Ho Jeong, Pum-Joon Kim, Kiyuk Chang, Sungmin Lim, Kwan-Yong Lee, Chul Soo Park, Wook-Sung Chung, Youngkeun Ahn, Ki-Dong Yoo, Suk-Min Seo, Chan-Joon Kim, Hee-Yeol Kim |
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| Rok vydání: | 2021 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty business.industry Hazard ratio acute myocardial infarction Atrial fibrillation General Medicine medicine.disease Article Confidence interval gender differences Interquartile range Internal medicine new onset atrial fibrillation ischemic stroke medicine Cardiology Medicine Myocardial infarction Risk factor business Stroke |
| Zdroj: | Journal of Clinical Medicine Volume 10 Issue 21 Journal of Clinical Medicine, Vol 10, Iss 5141, p 5141 (2021) |
| ISSN: | 2077-0383 |
| Popis: | Background: Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. Methods: We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. Results: Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09–3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03–7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79–9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21–5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16–11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. Conclusions: Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women. |
| Databáze: | OpenAIRE |
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