Impact of Gender on the Prognosis of Patients With Nonvalvular Atrial Fibrillation

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• 作者：Hiroshi Inoue ; MD^a ; ^{hiroshi@med.u-toyama.ac.jp" class="auth_mail} ; Hirotsugu Atarashi ; MD^b ; Ken Okumura ; MD^c ; Takeshi Yamashita ; MD^d ; Hideki Origasa ; PhD^e ; Naoko Kumagai ; MS^f ; Masayuki Sakurai ; MD^g ; Yuichiro Kawamura ; MD^h ; Isao Kubota ; MDⁱ ; Kazuo Matsumoto ; MD^j ; Yoshiaki Kaneko ; MD^k ; Satoshi Ogawa ; MD^l ; Yoshifusa Aizawa ; MD^m ; Masaomi Chinushi ; MDⁿ ; Itsuo Kodama ; MD^o ; Eiichi Watanabe ; MD^p ; Yukihiro Koretsune ; MD^q ; Yuji Okuyama ; MD^r ; Akihiko Shimizu ; MD^s ; Osamu Igawa ; MD^t ; Shigenobu Bando ; MD^u ; Masahiko Fukatani ; MD^v ; Tetsunori Saikawa ; MD^w ; Akiko Chishaki ; MD^x ; on behalf of the J-RHYTHM Registry Investigators
• 刊名：The American Journal of Cardiology
• 出版年：15 March, 2014
• 年：2014
• 卷：113
• 期：6
• 页码：957-962
• 全文大小：154 K

文摘

Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70聽years) who were followed-up prospectively for 2聽years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n聽= 5,241), female subjects (n聽= 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and coronary artery disease. Male and female patients had mean CHADS₂ (Congestive heart failure, Hypertension, Age of 75 years or more, Diabetes mellitus and prior Stroke or transient ischemic attack) scores of 1.6 and 1.8, respectively (p <0.001). Warfarin was given to 87% of male patients and 86% of female patients (p聽= 0.760), and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline (1.91 vs 1.90, respectively, p聽= 0.756). Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging (odds ratio 1.59, 95% confidence interval 1.05 to 2.40, p聽= 0.027) and all-cause mortality (odds ratio 1.78, 95% confidence interval 1.25 to 2.55, p聽<0.002) but not for thromboembolic events (odds ratio 1.24, 95% confidence interval 0.83 to 1.86, p聽= 0.297) or cardiovascular mortality (odds ratio 0.96, 95% confidence interval 0.56 to 1.66, p聽= 0.893). In conclusion, female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin. However, male gender is a risk factor for major hemorrhaging and all-cause mortality.