心房颤动与女性：欧洲大型队列中口服抗凝剂的使用及血栓栓塞和中风的残余风险

Atrial fibrillation and female sex: use of oral anticoagulants in a large European cohort and residual risk of thromboembolism and stroke.

作者信息

Mei Davide Antonio, Romiti Giulio Francesco, Vitolo Marco, Imberti Jacopo Francesco, Corica Bernadette, Mantovani Marta, Bonini Niccolò, Marin Francisco, Diemberger Igor, Dan Gheorghe Andrei, Potpara Tatjana, Proietti Marco, Lip Gregory Y H, Boriani Giuseppe

机构信息

Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.

Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2025 Aug 4. doi: 10.1093/ehjqcco/qcaf075.

DOI:10.1093/ehjqcco/qcaf075

PMID:40755396

Abstract

BACKGROUND

The role of female sex in stroke risk and oral anticoagulant (OAC) use in atrial fibrillation (AF) remains controversial. This study evaluates sex-specific differences in OAC prescription, residual risk of stroke/TIA and thromboembolism (STE), and the predictive performance of CHA₂DS₂-VASc vs. CHA₂DS₂-VA scores.

METHODS

We analyzed data from a European prospective cohort. The association between female sex and OAC prescription was assessed in patients with CHA₂DS₂-VA score ≥1. We analyzed the residual STE risk in OAC-treated patients and compared the predictive performance of CHA₂DS₂-VASc and CHA₂DS₂-VA scores.

RESULTS

Among 10,080 patients (41.8% women; mean age 69.7 [SD 10.7] years) with CHA₂DS₂-VA ≥1, women had higher burden of comorbidities and less likely to receive OACs than men (OR 0.79, 95% CI: 0.69-0.90). In OAC-treated patients, STE rates were higher in women (IR 1.33 vs. 0.94 per 100 person-years). After adjusting for confounders and the competing risk of death, female sex was not statistically significantly associated with an increased risk of STE (sHR 1.24, 95% CI 0.89-1.74, P=0.210). CHA₂DS₂-VA and CHA₂DS₂-VASc scores had similar predictive performance (AUC 0.603 vs. 0.605, P=0.665). CHA₂DS₂-VA showed worse (ie. negative) reclassification compared to CHA₂DS₂-VASc (net reclassification index -0.088, 95% CI -0.164 to -0.001), with no significant differences in discrimination or net benefit.

CONCLUSIONS

In AF patients treated with OAC, the increased residual risk of STE associated with female sex was non-significant after adjusting for confounders and the competing risk of death. Both scores had similar predictive performance but CHA₂DS₂-VA showed worse reclassification compared to CHA₂DS₂-VASc.

摘要

背景

女性性别在房颤（AF）患者中风风险及口服抗凝药（OAC）使用方面的作用仍存在争议。本研究评估了OAC处方的性别差异、中风/短暂性脑缺血发作（TIA）和血栓栓塞（STE）的残余风险，以及CHA₂DS₂-VASc与CHA₂DS₂-VA评分的预测性能。

方法

我们分析了来自一个欧洲前瞻性队列的数据。在CHA₂DS₂-VA评分≥1的患者中评估女性性别与OAC处方之间的关联。我们分析了接受OAC治疗患者的残余STE风险，并比较了CHA₂DS₂-VASc和CHA₂DS₂-VA评分的预测性能。

结果

在10,080例CHA₂DS₂-VA≥1的患者中（41.8%为女性；平均年龄69.7[标准差10.7]岁），女性合并症负担较重，接受OAC治疗的可能性低于男性（比值比0.79，95%置信区间：0.69-0.90）。在接受OAC治疗的患者中，女性的STE发生率较高（每100人年发生率为1.33 vs. 0.94）。在调整混杂因素和死亡竞争风险后，女性性别与STE风险增加无统计学显著关联（标准化危险比1.24，95%置信区间0.89-1.74，P=0.210）。CHA₂DS₂-VA和CHA₂DS₂-VASc评分具有相似的预测性能（曲线下面积0.603 vs. 0.605，P=0.665）。与CHA₂DS₂-VASc相比，CHA₂DS₂-VA显示出更差（即负向）的重新分类（净重新分类指数-0.088，95%置信区间-0.164至-0.001），在鉴别能力或净效益方面无显著差异。