Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction

Jeong Eun Yi; Suk Min Seo; Sungmin Lim; Eun Ho Choo; Ik Jun Choi; Kwan Yong Lee; Byung Hee Hwang; Chan Joon Kim; Mahn Won Park; Dong Bin Kim; Sung Ho Her; Jong Min Lee; Chul Soo Park; Pum Joon Kim; Hee Yeol Kim; Ki Dong Yoo; Doo Soo Jeon; Wook Sung Chung; Myung Ho Jeong; Youngkeun Ahn; Kiyuk Chang

doi:10.3390/jcm10215141

Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction

Jeong Eun Yi, Suk Min Seo, Sungmin Lim, Eun Ho Choo, Ik Jun Choi, Kwan Yong Lee, Byung Hee Hwang, Chan Joon Kim, Mahn Won Park, Dong Bin Kim, Sung Ho Her, Jong Min Lee, Chul Soo Park, Pum Joon Kim, Hee Yeol Kim, Ki Dong Yoo, Doo Soo Jeon, Wook Sung Chung, Myung Ho Jeong, Youngkeun AhnKiyuk Chang

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Abstract

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.

Original language	English
Article number	5141
Journal	Journal of Clinical Medicine
Volume	10
Issue number	21
DOIs	https://doi.org/10.3390/jcm10215141
State	Published - 1 Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

Acute myocardial infarction
Gender differences
Ischemic stroke
New onset atrial fibrillation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/jcm10215141

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Yi, J. E., Seo, S. M., Lim, S., Choo, E. H., Choi, I. J., Lee, K. Y., Hwang, B. H., Kim, C. J., Park, M. W., Kim, D. B., Her, S. H., Lee, J. M., Park, C. S., Kim, P. J., Kim, H. Y., Yoo, K. D., Jeon, D. S., Chung, W. S., Jeong, M. H., ... Chang, K. (2021). Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction. Journal of Clinical Medicine, 10(21), Article 5141. https://doi.org/10.3390/jcm10215141

@article{ed1e4a1efded4831b60cbb7307c5423b,

title = "Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction",

abstract = "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.",

keywords = "Acute myocardial infarction, Gender differences, Ischemic stroke, New onset atrial fibrillation",

author = "Yi, {Jeong Eun} and Seo, {Suk Min} and Sungmin Lim and Choo, {Eun Ho} and Choi, {Ik Jun} and Lee, {Kwan Yong} and Hwang, {Byung Hee} and Kim, {Chan Joon} and Park, {Mahn Won} and Kim, {Dong Bin} and Her, {Sung Ho} and Lee, {Jong Min} and Park, {Chul Soo} and Kim, {Pum Joon} and Kim, {Hee Yeol} and Yoo, {Ki Dong} and Jeon, {Doo Soo} and Chung, {Wook Sung} and Jeong, {Myung Ho} and Youngkeun Ahn and Kiyuk Chang",

note = "Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2021",

month = nov,

day = "1",

doi = "10.3390/jcm10215141",

language = "English",

volume = "10",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "21",

}

Yi, JE, Seo, SM, Lim, S , Choo, EH , Choi, IJ , Lee, KY , Hwang, BH , Kim, CJ , Park, MW, Kim, DB, Her, SH, Lee, JM, Park, CS, Kim, PJ, Kim, HY , Yoo, KD , Jeon, DS, Chung, WS, Jeong, MH, Ahn, Y & Chang, K 2021, 'Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction', Journal of Clinical Medicine, vol. 10, no. 21, 5141. https://doi.org/10.3390/jcm10215141

TY - JOUR

T1 - Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction

AU - Yi, Jeong Eun

AU - Seo, Suk Min

AU - Lim, Sungmin

AU - Choo, Eun Ho

AU - Choi, Ik Jun

AU - Lee, Kwan Yong

AU - Hwang, Byung Hee

AU - Kim, Chan Joon

AU - Park, Mahn Won

AU - Kim, Dong Bin

AU - Her, Sung Ho

AU - Lee, Jong Min

AU - Park, Chul Soo

AU - Kim, Pum Joon

AU - Kim, Hee Yeol

AU - Yoo, Ki Dong

AU - Jeon, Doo Soo

AU - Chung, Wook Sung

AU - Jeong, Myung Ho

AU - Ahn, Youngkeun

AU - Chang, Kiyuk

PY - 2021/11/1

Y1 - 2021/11/1

N2 - 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.

AB - 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.

KW - Acute myocardial infarction

KW - Gender differences

KW - Ischemic stroke

KW - New onset atrial fibrillation

UR - http://www.scopus.com/inward/record.url?scp=85118228034&partnerID=8YFLogxK

U2 - 10.3390/jcm10215141

DO - 10.3390/jcm10215141

M3 - Article

AN - SCOPUS:85118228034

SN - 2077-0383

VL - 10

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 21

M1 - 5141

ER -

Gender differences in the impact of new-onset atrial fibrillation on long-term risk of ischemic stroke after acute myocardial infarction

Abstract

Bibliographical note

Keywords

UN SDGs

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