Sex difference in clinical outcomes of Chinese patients with atrial fibrillation and coronary stenting according to age

Abstract

Objective: Sex differences in the clinical outcomes of patients with atrial fibrillation (AF) and coronary stenting should be assessed according to age. Methods: We analyzed the clinical data of all patients with nonvalvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. Results: A total of 2,146 patients (71.8% men and 28.2% women) were included in the study. The mean age of the patients was 66.6±9.4 years. Women in this study were older and had higher prevalence of hypertension, diabetes, chronic kidney disease (CKD), and anemia. Smoking history was found to be higher in men, and women were less likely to be current smokers. The mean follow-up duration was 39.7 months. Women younger than 65 years had a remarkably higher mortality (11.2% vs. 5.3%, p=0.012) and a significantly lower rate of repeat revascularization (1.6% vs. 6.3%, p=0.034) than men. Female gender remained an independent predictor for all-cause mortality [hazard ratio (HR)=2.03, 95% confidence interval (CI): 1.09–3.79, p=0.025], along with heart failure (HR=3.64, 95% CI: 2.02–6.57, p<0.001) and CKD (HR=2.46, 95% CI: 1.09–5.57, p=0.031) after multivariate regression analysis. No significant difference was noted between men and women with regard to mortality, ischemic events, and major bleeding in elderly patients. Conclusion: In Chinese patients younger than 65 years with AF and coronary stenting, female gender was independently associated with increased mortality; men were more likely to receive repeat revascularization possibly due to the current smoking. Whether it was a biological difference or a recognition disparity of the disease between men and women warrants further investigation.

CHA2DS2-VASc score as a prognostic indicator in patients with atrial fibrillation undergoing coronary stenting

“…In addition, increasing CHA 2 DS 2 -VASc score was associated with increased risk of stroke and higher mortality in an Australian registry of 564 AF patients undergoing PCI [ 12 ]. The association reflected the fact that the major components in the CHA 2 DS 2 -VASc score were common risk factors and prognostic indicators for both CAD and AF [ 6 , 8 , 13 , 14 ]. In addition, our study showed a good correlation of the CHA2DS2-VASc score with the GRACE score, which has long been demonstrated to predict adverse clinical outcomes reliably in acute coronary syndrome.…”

“…Nowadays, percutaneous coronary intervention (PCI) with stenting remains the most effective treatment to relieve symptoms in patients with coronary atherosclerotic disease (CAD) and improve prognosis in the acute setting. Approximately 4.5%–12.3% of patients undergoing PCI had atrial fibrillation (AF) [ 1 – 6 ]. In the past decade, cardiologists have focused their attention on this special population who showed an increased thromboembolic risk and worse prognosis compared with those without AF [ 1 – 4 ].…”