Giuseppe Boriani1,2, Gregory Y H Lip3,4, Renato Pietro Ricci5, Alessandro Proclemer6, Maurizio Landolina7,8, Maurizio Lunati9, Luigi Padeletti10,11, Gabriele Zanotto12, Giulio Molon13, Mauro Biffi2, Roberto Rordorf7, Fabio Quartieri14, Maurizio Gasparini15. 1. Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. 2. Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy. 3. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. 4. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 5. Cardiology Division, San Filippo Neri Hospital, Roma, Italy. 6. Cardiology Division, S. Maria della Misericordia Hospital, Udine; Italy. 7. Cardiology Division, Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy. 8. Cardiology Division, Ospedale Maggiore, Crema (Cremona), Italy. 9. Cardiology Division, Niguarda Ca' Granda Hospital, Milano, Italy. 10. Cardiology, University of Firenze, Italy. 11. IRCCS Multimedica, Milano, Italy. 12. Mater Salutis Hospital, Legnago (Verona), Italy. 13. Department of Cardiology, Sacro Cuore Hospital, Negrar, Verona, Italy. 14. Division of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 15. IRCCS Istituto Clinico Humanitas, Rozzano (Milano), Italy.
Abstract
AIMS: To evaluate if the increased thromboembolic risk in female patients may be related to a higher burden of atrial fibrillation (AF). METHODS AND RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01007474. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To evaluate if the increased thromboembolic risk in female patients may be related to a higher burden of atrial fibrillation (AF). METHODS AND RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01007474. Published on behalf of the European Society of Cardiology. All rights reserved.