Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction

• Published in: Journal of clinical medicine Vol. 10; no. 21; p. 5141
• Main Authors: Yi, Jeong-Eun, Seo, Suk-Min, Lim, Sungmin, Choo, Eun-Ho, Choi, Ik-Jun, Lee, Kwan-Yong, Hwang, Byung-Hee, Kim, Chan-Joon, Park, Mahn-Won, Kim, Dong-Bin, Her, Sung-Ho, Lee, Jong-Min, Park, Chul-Soo, Kim, Pum-Joon, Kim, Hee-Yeol, Yoo, Ki-Dong, Jeon, Doo-Soo, Chung, Wook-Sung, Jeong, Myung-Ho, Ahn, Youngkeun, Chang, Kiyuk
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.11.2021; MDPI
• Subjects: Acute coronary syndromes; Age; Anticoagulants; Body mass index; Cardiac arrhythmia; Cardiovascular disease; Clinical medicine; Diabetes; Enrollments; Gender differences; Heart attacks; Hypertension; Medical records; Patients; Population; Stroke; Womens health
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10215141

Background: Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. Methods: We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. Results: Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09–3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03–7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79–9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21–5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16–11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. Conclusions: Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women.