Sex-Related Differences in the Clinical Events of Patients With Atrial Fibrillation. - The Fushimi AF Registry
Sex-Related Differences in the Clinical Events of Patients With Atrial Fibrillation. - The Fushimi AF Registry
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DOI：
10.1253/circj.cj-17-0071
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发表时间：
2017-10-01
影响因子：
3.3
通讯作者：
Akao, Masaharu
中科院分区：
文献类型：
--
作者：
Ogawa, Hisashi;Hamatani, Yasuhiro;Akao, Masaharu
背景：女性被认为是房颤患者血栓栓塞症的危险因素，并被纳入危险分层方案CHA2DS2-VASc评分。本研究的目的是调查日本女性房颤患者的临床转归。方法和结果：房颤登记处是一项以社区为基础的前瞻性调查，调查对象为京都富士区的房颤患者。3878名患者获得了随访数据。女性房颤患者(n=1,551，40.0%)年龄(77.0vs.71.4岁；P<；0.001)高于男性患者(n=2,327，60.0%)。女性患者更容易发生心力衰竭(31.1%vs.23.7%；P<；0.001)。既往中风发生率(19.2%vs.21.4%；P=0.083)在男性和女性患者中相似。在中位数为1,102天的随访期内，COX回归分析显示女性与中风或系统性血栓的风险并不独立相关(调整后的危险比[HR]0.74；95%可信区间[CI]：0.54-1.00，P=0.051)。然而，女性与较低的颅内出血风险(调整后的HR0.54；95%CI：0.30-0.95，P=0.032)和全因死亡(调整后的HR为0.56；95%CI：0.46-0.68，P<；0.001)相关。
Background: Female sex is considered a risk factor for thromboembolism in patients with atrial fibrillation (AF), and is included in the risk stratification scheme, CHA2DS2-VASc score. The purpose of the present study was to investigate the clinical outcomes of female Japanese AF patients.Methods and Results: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto. Follow-up data were available for 3,878 patients. Female AF patients (n=1,551, 40.0%) were older (77.0 vs. 71.4 years; P< 0.001) than male patients (n=2,327, 60.0%). Female patients were more likely to have heart failure (31.1% vs. 23.7%; P< 0.001). Previous stroke incidence (19.2% vs. 21.4%; P=0.083) was comparable between male and female patients. During the median follow-up period of 1,102 days, Cox regression analysis demonstrated that female sex was not independently associated with a risk of stroke or systemic embolism (adjusted hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.54-1.00, P=0.051). However, female sex showed an association with a lower risk of intracranial hemorrhage (adjusted HR 0.54; 95% CI: 0.30-0.95, P=0.032) and all-cause death (adjusted HR 0.56; 95% CI: 0.46-0.68, P< 0.001).Conclusions: We demonstrated that female sex is not independently associated with an increased risk of thromboembolism, but is associated with a decreased risk of intracranial hemorrhage and all-cause death in Japanese AF patients enrolled in the Fushimi AF Registry.