European heart journal. Quality of care & clinical outcomes · 2025
Atrial fibrillation and female sex: use of oral anticoagulants in a large European cohort and residual risk of thromboembolism and stroke.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Mei Davide Antonio, Romiti Giulio Francesco, Vitolo Marco, Imberti Jacopo Francesco, Corica Bernadette, Mantovani Marta, Bonini Niccolò, Marin Francisco, Diemberger Igor, Dan Gheorghe Andrei, Potpara Tatjana, Proietti Marco, Lip Gregory Y H, Boriani Giuseppe
Аннотация
AIMS: The role of female sex in stroke risk and oral anticoagulant (OAC) use in atrial fibrillation (AF) remains controversial. This study evaluates sex-specific differences in OAC prescription, residual risk of stroke/TIA and systemic thromboembolism (STE), and the predictive performance of CHA2DS2-VASc vs. CHA2DS2-VA scores.
METHODS AND RESULTS: We analysed data from a European prospective cohort. The association between female sex and OAC prescription was assessed in patients with CHA2DS2-VA score ≥ 1. We analysed the residual STE risk in OAC-treated patients and compared the predictive performance of CHA2DS2-VASc and CHA2DS2-VA scores. Among 10 080 patients [41.8% women; mean age 70.1 (SD 10.0) years] with CHA2DS2-VA ≥1, women had higher burden of comorbidities and less likely to receive OACs than men (OR 0.79, 95% CI: 0.69-0.90). In OAC-treated patients, STE rates were higher in women (IR 1.33 vs. 0.94 per 100 person-years). After adjusting for confounders and the competing risk of death, female sex was not statistically significantly associated with an increased risk of STE (sHR 1.24, 95% CI 0.89-1.74, P = 0.210). CHA2DS2-VA and CHA2DS2-VASc scores had similar predictive performance (AUC 0.603 vs. 0.605, P = 0.665). CHA2DS2-VA showed worse (i.e. negative) reclassification compared with CHA2DS2-VASc (net reclassification index -0.088, 95% CI -0.164 to -0.001), with no significant differences in discrimination or net benefit.
CONCLUSION: In AF patients treated with OAC, the increased residual risk of STE associated with female sex was non-significant after adjusting for confounders and the competing risk of death. Both scores had similar predictive performance but CHA2DS2-VA showed worse reclassification compared with CHA2DS2-VASc.
METHODS AND RESULTS: We analysed data from a European prospective cohort. The association between female sex and OAC prescription was assessed in patients with CHA2DS2-VA score ≥ 1. We analysed the residual STE risk in OAC-treated patients and compared the predictive performance of CHA2DS2-VASc and CHA2DS2-VA scores. Among 10 080 patients [41.8% women; mean age 70.1 (SD 10.0) years] with CHA2DS2-VA ≥1, women had higher burden of comorbidities and less likely to receive OACs than men (OR 0.79, 95% CI: 0.69-0.90). In OAC-treated patients, STE rates were higher in women (IR 1.33 vs. 0.94 per 100 person-years). After adjusting for confounders and the competing risk of death, female sex was not statistically significantly associated with an increased risk of STE (sHR 1.24, 95% CI 0.89-1.74, P = 0.210). CHA2DS2-VA and CHA2DS2-VASc scores had similar predictive performance (AUC 0.603 vs. 0.605, P = 0.665). CHA2DS2-VA showed worse (i.e. negative) reclassification compared with CHA2DS2-VASc (net reclassification index -0.088, 95% CI -0.164 to -0.001), with no significant differences in discrimination or net benefit.
CONCLUSION: In AF patients treated with OAC, the increased residual risk of STE associated with female sex was non-significant after adjusting for confounders and the competing risk of death. Both scores had similar predictive performance but CHA2DS2-VA showed worse reclassification compared with CHA2DS2-VASc.