Sex Differences in Long-Term Clinical Outcomes in Patients With Atrial Fibrillation Undergoing Coronary Stent Implantation

作者：Matsumura Nakano Yukiko; Shiomi Hiroki^*; Morimoto Takeshi; Shizuta Satoshi; Yamaji Kyohei; Watanabe Hirotoshi; Yoshikawa Yusuke; Taniguchi Tomohiko; Kawaji Tetsuma; Natsuaki Masahiro; Akasaka Takashi; Hanaoka Keiichi; Kadota Kazushige; Kozuma Ken; Tanabe Kengo; Nakagawa Yoshihisa; Muramatsu Toshiya; Morino Yoshihiro; Ando Kenji; Kimura Takeshi

来源：Circulation Journal, 2018, 82(7): 1754-+.

DOI：10.1253/circj.CJ-17-1278

• Atrial fibrillation
• Coronary artery disease
• Outcomes
• Sex

Background: Patients with concomitant atrial fibrillation (AF) and coronary stenting are at high risk for both cardiovascular and bleeding events. We aimed to evaluate the influence of sex on long-term clinical outcomes in this patient subset.
Methods and Results: We identified 1,450 patients with AF and coronary stenting in a patient-level pooled database from 3 Japanese studies, and compared 3-year clinical outcomes between men and women (n=1,075, and n=375, respectively). The cumulative 3-year incidence of all-cause death was significantly higher in women than in men (26.5% vs. 17.2%, log-rank P<0.001), although after adjusting for confounders, the excess mortality risk of women relative to men was no longer significant (hazard ratio (HR): 1.12, 95% confidence interval (CI): 0.85-1.46, P=0.42). There were no significant differences in the adjusted 3-year risks for myocardial infarction or stroke between men and women (HR: 1.25, 95% CI: 0.62-2.40, P=0.52, and HR: 1.15, 95% CI: 0.75-1.74, P=0.52, respectively). However, both the cumulative 3-year incidence of and adjusted risk for major bleeding were significantly higher in women than in men (17.0% vs. 11.3%, log-rank P=0.002, and HR: 1.47, 95% CI: 1.03-2.07, P=0.03).
Conclusions: Among patients with concomitant AF and coronary stenting, there were no significant differences in the adjusted 3-year risks for all-cause death, myocardial infarction, and stroke between men and women. However, women as compared with men were associated with excess adjusted risk for major bleeding.

• 出版日期2018-7