In women with coronary artery disease, atrial fibrillation was strongly associated with an increased risk of cardiac death over a 10-year follow-up (HR 5.20; 95% CI 1.72-15.77; p=0.004).
Cohort (n=1,946)
In women with coronary artery disease, atrial fibrillation, elevated hs-TnT, higher systolic blood pressure, and higher post-revascularization Syntax Scores are strong independent predictors of cardiac death over a 10-year period.
Effect estimate: HR 5.20 (95% CI 1.72-15.77)
p-value: p=0.004
Abstract Background Coronary artery disease (CAD) is a leading cause of mortality, with women accounting for approximately 43% of cases. Emerging evidence suggests that CAD differs in its presentation and progression in women, potentially affecting detection, management, and prognosis. Aim This study aimed to identify factors associated with cardiac death in women with CAD. Methods This study utilized data from the ARTEMIS cohort, comprising 1,946 patients (619 women) with angiographically confirmed CAD, of whom we included individuals who experienced cardiac death or aborted sudden cardiac arrest during a 10-year follow-up. The primary endpoint was cardiac death, encompassing both sudden (SCD) and non-sudden (NSCD) cases, which were analyzed separately as secondary endpoints. We examined associations between cardiac death and traditional CAD risk factors, echocardiographic parameters (left ventricular ejection fraction LVEF and mass), electrocardiographic (ECG) abnormalities, Canadian Cardiovascular Society (CCS) grade, creatine clearance (CrCl), high-sensitivity troponin T (hs-TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (hs-CRP). Factors identified as statistically significant in the univariate analysis were included in a multivariate Cox regression model to determine factors with independent associations with cardiac death. Results Cardiac death occurred in 7.6% (N=47) of women during follow-up. In univariate analysis, factors significantly associated with cardiac death in women with CAD included age, systolic BP, Syntax Score (both pre- and post-revascularization), CrCl, BNP, hs-TnT, type 2 diabetes, higher CCS grades, Q waves, atrial fibrillation (AF), and T wave inversions. In contrast, low-density lipoprotein levels, hs-CRP, LVEF, LVM, and ECG abnormalities including left bundle branch block, left ventricular hypertrophy, and abnormal QTc did not show a statistically significant association with cardiac death. Independent risk factors for cardiac death included age (HR 1.10 per year, 95% CI 1.04–1.17, p=0.001), post-revascularization Syntax Score (HR 1.05 per unit increase, 95% CI 1.01–1.08, p=0.007), systolic blood pressure (BP) (HR 1.01 per unit increase, 95% CI 1.00–1.03, p=0.030), hs-TnT (HR 1.05 per unit increase, 95% CI 1.02–1.07, p0.001), and AF (HR 5.20, 95% CI 1.72-15.77, p=0.004). Post-revascularization Syntax Score was significantly associated only with SCD, while elevated systolic BP and higher hs-TnT levels were specifically linked with NSCD. AF was particularly emphasized in women with CAD and NSCD. Conclusions Higher post-revascularization Syntax Scores, systolic BP levels and hs-TnT levels are associated with elevated risk of cardiac death in women with CAD. AF demonstrated a particularly strong association with cardiac death in this population, suggesting that prioritizing the treatment and prevention of AF could help reduce cardiac mortality in women with CAD.Table 1 Figure 1
King et al. (Sat,) conducted a cohort in Coronary artery disease (n=1,946). Risk factors (including atrial fibrillation, age, Syntax Score, systolic BP, hs-TnT) was evaluated on Cardiac death (sudden and non-sudden) (HR 5.20, 95% CI 1.72-15.77, p=0.004). In women with coronary artery disease, atrial fibrillation was strongly associated with an increased risk of cardiac death over a 10-year follow-up (HR 5.20; 95% CI 1.72-15.77; p=0.004).