Background: Limited data exists on the impact of sex on outcomes in non-valvular atrial fibrillation (NVAF) patients undergoing percutaneous coronary intervention (PCI). We explored the impact of sex on ischemic and bleeding events in these patients within 1-year.
Methods: A prospective register included 1021 patients with NVAF undergoing PCI and 253 (24.8%) were women. The primary end point was a composite of cardiovascular death, stroke or systemic embolism (SSE). The secondary end-point was major bleeding events defined as a Bleeding Academic Research Consortium (BARC ≥ 3a).
Results: Women were older (76.8 ± 7.7 vs 71.8 ± 9.1 years, p < 0.0001), and presented more often CHA2DS2-VASc ≥ 2 (adjusted HR 1.15; 95%CI 1.13-1.18, p < 0.0001) and HAS-BLED ≥ 3 (adjusted HR 1.12; 95%CI 1.10-1.14, p < 0.0001) than men. The use of oral anticoagulant at discharge was similar in both sexes (55.9% vs 56.5%, p = 0.45). The time in therapeutic range (TTR ≥ 65%) was lower in women than in men (35.6 ± 24.6% vs 48.9 ± 27.2%, p = 0.002). The incidence of adverse events was higher in women (39.9% vs 28.9%, p = 0.01). After adjusting for confounder variables, cardiovascular death or SSE rate (16.6% vs 10.4%; adjusted HR 1.58; 95%CI 1.07-2.31; p = 0.01) and major bleeding (11.5% vs 5.0%; adjusted HR 2.17; 95%CI 1.31-3.59; p = 0.003) were higher in women, as was cardiovascular death (adjusted HR 1.71; 95%CI, 1.18-2.46, p = 0.004). TTR was negatively correlated with any bleeding event in women (r = -0.41; p = 0.03).
Conclusions: Female with NVAF undergoing PCI showed a lower TTR than men and TTR was associated with bleeding events. Female sex was an independent risk factor for cardiovascular death and major bleeding.
Keywords: Anticoagulant; Atrial fibrillation; Percutaneous coronary intervention; Prognosis; Women.
Copyright © 2019. Published by Elsevier Ltd.