Author`s Reply.

To the Editor,

We would like to thank the reviewers for their valuable and constructive comments related to our article entitled “Comparative performance of Anticoagulation and Risk factors In Atrial fibrillation and Global Registry of Acute Coronary Events risk scores in predicting long-term adverse events in patients with acute myocardial infarction” which was published in Anatol J Cardiol 2018; 20: 77-84 (1). Although we agree that female gender is a risk factor for major adverse cardiovascular events after acute myocardial infarction (AMI), advanced age is the predominant risk factor for both cardiovascular and cerebrovascular diseases and an independent predictor of poor outcomes, as mentioned in our study (2). Even though female gender is assigned 1 point in ATRIA risk score, age is more profoundly represented in this scoring system (i.e., 6 points for age >85 years, 5 points for age 75–84 years, 3 points for age 65–74 years). It is a fact that elderly patients have a poorer prognosis after AMI due to not receiving evidence-based medical therapy, increased risk of bleeding, lower rate of undergoing CAG and/or PCI, delay in hospital admission, higher prevalence of comorbidities such as renal and hepatic insufficiency, heart failure, hypertension, DM, and their vulnerable health status (2, 3). Age was a major risk factor for ATRIA RS, which explains its appropriateness for risk stratification in patients with AMI. In addition, we performed a subgroup analysis involving only male patients in which ATRIA >3 was still an independent predictor of prognosis (hazard ratio 1.90, 95% confidence interval 1.38–2.62, p<0.001). In our recent study, we showed that there were no in-hospital and 30-day mortality differences between male and female octogenarian patients after AMI. However, female octogenarian patients had poorer outcomes than male patients at long-term follow-up (4).