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

J Clin Med. 2021 Nov 1;10(21):5141. doi: 10.3390/jcm10215141.

Authors

Jeong-Eun Yi¹, Suk-Min Seo¹, Sungmin Lim², Eun-Ho Choo³, Ik-Jun Choi⁴, Kwan-Yong Lee³, Byung-Hee Hwang³, Chan-Joon Kim², Mahn-Won Park⁵, Dong-Bin Kim⁶, Sung-Ho Her⁷, Jong-Min Lee², Chul-Soo Park⁸, Pum-Joon Kim¹, Hee-Yeol Kim⁶, Ki-Dong Yoo⁷, Doo-Soo Jeon⁴, Wook-Sung Chung³, Myung-Ho Jeong⁹, Youngkeun Ahn⁹, Kiyuk Chang³

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
² Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
³ Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁴ Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁵ Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁶ Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁷ Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁸ Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
⁹ Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea.

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.