Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Europace. 2017 Nov 1;19(11):1767-1775. doi: 10.1093/europace/euw333.
To evaluate if the increased thromboembolic risk in female patients may be related to a higher burden of atrial fibrillation (AF).
Data collected in a prospective observational research of patients implanted with a cardiac implantable electrical device (CIED) were analysed. We included 2398 patients: 489 (20.4%) were female and 1909 (79.6%) were male (oral anticoagulants treatment in 23.2%, independent of gender). During the follow-up (mean 42.8, median 37.7 months), 26 thromboembolic events occurred in 22 patients, with an incidence rate ratio of both stroke and stroke/transient ischemic attack (TIA) significantly higher in females compared with males [2.00, 95% confidence interval (CI) 1.53-2.61, P< 0.001 for stroke; 1.77 (95% C1.37-2.31, P< 0.001 for stroke/TIA]. An AF burden ≥5 min was a common finding (44% of patients), with no difference between men and women. The maximum daily AF burden and the time to evolution in permanent AF did not differ according to gender. The results of multivariate Cox regression showed that female gender, as well as history of CABG, were significant independent predictors of stroke and female gender was also an independent predictor of stroke/TIA.
Among patients implanted with a CIED, an AF burden of at least 5 min is a common finding, (44% of patients). Female patients have a risk of stroke and TIAs that is around two-fold that of male patients, but this increased risk cannot be ascribed to a higher burden of AF or to differences in the evolution to permanent AF.
ClinicalTrials.gov Identifier: NCT01007474.
评估女性患者血栓栓塞风险增加是否与心房颤动（AF）负担加重有关。
分析了一项前瞻性观察性研究中植入心脏植入式电子设备（CIED）患者的数据。共纳入 2398 例患者：其中 489 例（20.4%）为女性，1909 例（79.6%）为男性（无论性别，口服抗凝治疗率为 23.2%）。在随访期间（平均 42.8 个月，中位数 37.7 个月），22 例患者发生 26 例血栓栓塞事件，女性的卒中及卒中/短暂性脑缺血发作（TIA）发生率均显著高于男性[2.00，95%置信区间（CI）1.53-2.61，P<0.001 用于卒中；1.77（95%CI 1.37-2.31，P<0.001 用于卒中/TIA]。AF 负荷≥5 分钟是一种常见发现（44%的患者），男性和女性之间没有差异。最大每日 AF 负荷和向永久性 AF 演变的时间在性别之间没有差异。多变量 Cox 回归的结果表明，女性性别以及 CABG 史是卒中的显著独立预测因素，而女性性别也是卒中/TIA 的独立预测因素。
在植入 CIED 的患者中，AF 负荷至少 5 分钟是一种常见发现（44%的患者）。女性患者发生卒中和 TIA 的风险是男性患者的两倍左右，但这种增加的风险不能归因于 AF 负担增加或向永久性 AF 演变的差异。
ClinicalTrials.gov 标识符：NCT01007474。
