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. 2022 Oct 1;11(19):5843.
doi: 10.3390/jcm11195843.

Sex-Related Differences in Clinical Outcomes in Patients with Atrial Fibrillation and Coronary Artery Disease: A Sub-Study of the MISOAC-AF Randomized Controlled Trial

Alexandra Bekiaridou  1   2 , Athanasios Samaras  1 , Anastasios Kartas  1 , Andreas S Papazoglou  1 , Dimitrios V Moysidis  1 , Vasiliki Patsiou  1 , Stefanos Zafeiropoulos  1   2 , Antonios Ziakas  1 , George Giannakoulas  1 , Apostolos Tzikas  1   3
Affiliations

Sex-Related Differences in Clinical Outcomes in Patients with Atrial Fibrillation and Coronary Artery Disease: A Sub-Study of the MISOAC-AF Randomized Controlled Trial

Alexandra Bekiaridou et al. J Clin Med. .

Abstract

Background: There is limited "real-world" data on the prognostic role of gender in comorbid atrial fibrillation (AF) and coronary artery disease (CAD).

Methods: In this post-hoc analysis of the MISOAC-AF randomized trial (NCT: 02941978), consecutive patients with AF and CAD who were discharged from the cardiology ward between 2015 and 2018 were included. Multivariable Cox-regression analysis was performed for all-cause mortality and cardiovascular (CV) mortality. Competing-risk analysis was performed for the outcomes of stroke or systemic embolism, major bleeding, AF- or heart failure (HF)-related hospitalization, adjusted for the competing risk of all-cause death.

Results: Of 1098 patients with AF, 461 patients with comorbid CAD were analyzed. Women were older and more likely to have a history of diabetes mellitus and valvular heart disease, while men were more likely to have a history of smoking or myocardial infarction. Over a median follow-up of 31 months, 143 (43.4%) men and 71 (53.7%) women died. Women were at a higher risk for all-cause mortality (adjusted hazard ration [aHR] 1.65; 95% confidence interval [CI] 1.14-2.38) and stroke or systemic embolism (aHR 3.52; 95% CI 1.46-8.49) compared to men. The risks of CV mortality, major bleeding, AF-related hospitalization, and HF-related hospitalization were similar between genders.

Conclusions: In recently hospitalized patients with AF and comorbid CAD, the female gender was independently associated with increased all-cause mortality and thromboembolic events.

Keywords: atrial fibrillation; coronary artery disease; prognosis; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk of clinical outcomes according to gender. Abbreviations: AF, atrial fibrillation; CI, confidence interval; HF, heart failure; HR, hazard ratio; pt, patient.
Figure 2
Figure 2
Cumulative incidence of clinical outcomes according to gender. Abbreviations: AF, atrial fibrillation; CI, confidence interval; HF, heart failure; HR, hazard ratio.
Figure 3
Figure 3
Major subgroup analyses of all-cause mortality by gender. Abbreviations: AF, atrial fibrillation; eGFR, estimated Glomerular Filtration Rate; LVEF, left ventricular ejection fraction; OAC, oral anticoagulants; VKA, Vitamin-K antagonists; NOAC, Non-Vitamin K antagonist oral anticoagulants; HR, hazard ratio.
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References

    1. Zoni-Berisso M., Lercari F., Carazza T., Domenicucci S. Epidemiology of atrial fbrillation: European perspective. Clin. Epidemiol. 2014;6:213–220. doi: 10.2147/CLEP.S47385. - DOI - PMC - PubMed
    1. Van Gelder I.C., Groenveld H.F., Crijns H.J.G.M., Tuininga Y.S., Tijssen J.G.P., Alings A.M., Hillege H.L., Bergsma-Kadijk J.A., Cornel J.H., Kamp O., et al. Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. N. Engl. J. Med. 2010;362:1363–1373. doi: 10.1056/NEJMoa1001337. - DOI - PubMed
    1. Netzler P.C. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. Yearb. Cardiol. 2012;2012:490–492. doi: 10.1016/j.ycar.2012.02.044. - DOI
    1. Mostafa A., EL-Haddad M.A., Shenoy M., Tuliani T. Atrial fibrillation post cardiac bypass surgery. Avicenna J. Med. 2012;2:65–70. doi: 10.4103/2231-0770.102280. - DOI - PMC - PubMed
    1. Michniewicz E., Mlodawska E., Lopatowska P., Tomaszuk-Kazberuk A., Malyszko J. Patients with atrial fibrillation and coronary artery disease–Double trouble. Adv. Med. Sci. 2018;63:30–35. doi: 10.1016/j.advms.2017.06.005. - DOI - PubMed