{"id":116719,"date":"2018-03-11T10:45:57","date_gmt":"2018-03-11T10:45:57","guid":{"rendered":""},"modified":"2018-03-11T10:45:57","modified_gmt":"2018-03-11T10:45:57","slug":"analisis-de-la-incidencia-de-eventos-embolicos-hemorragicos-y-mortalidad-en-pacientes-con-fibrilacion-auricular-no-valvular-sometidos-a-cardioversion-electrica-de-nuestro-medio-utilidad-de-las-escal","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cardiologia\/analisis-de-la-incidencia-de-eventos-embolicos-hemorragicos-y-mortalidad-en-pacientes-con-fibrilacion-auricular-no-valvular-sometidos-a-cardioversion-electrica-de-nuestro-medio-utilidad-de-las-escal\/","title":{"rendered":"An\u00e1lisis de la incidencia de eventos embolicos, hemorragicos y mortalidad en pacientes con fibrilaci\u00f3n auricular no valvular sometidos a cardioversion electrica de nuestro medio. utilidad de las escalas de riesgo clinicas en la prediccion de la ocurrencia de eventos"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Amaya Garcia Fernandez <\/strong><\/h2>\n<p>Objetivos  los objetivos principales del presente trabajo son:  1.\tConocer la incidencia de las complicaciones tromboemb\u00f3licas, sangrado mayor y mortalidad (a corto y a largo plazo) en pacientes con fa no valvular de nuestro medio, que se someten a uno o varios procedimientos de cve. 2.\tValorar la utilidad de las escalas de riesgo emb\u00f3lico (chads2 y cha2ds2-vasc) para predecir la incidencia de eventos tromboemb\u00f3licos y mortalidad en nuestros pacientes. Valorar la utilidad de la escala de riesgo hemorr\u00e1gico has-bled, para predecir la incidencia de hemorragias mayores y mortalidad en nuestros pacientes.   m\u00e9todos  se trata de un estudio observacional, retrospectivo, descriptivo, en el cual se recogieron datos cl\u00ednicos, ecocardiogr\u00e1ficos y anal\u00edticos de 406 pacientes sometidos a 571 procedimientos consecutivos de cve por fa no valvular, realizados en la unidad de arritmias del hospital general universitario de alicante entre enero de 2008 y junio de 2012. Se calcul\u00f3 la puntuaci\u00f3n en las escalas chads2, cha2ds2-vasc y has-bled en el momento de inclusi\u00f3n en el estudio. Se registr\u00f3 la incidencia de eventos tromboemb\u00f3licos, sangrado mayor y mortalidad, siendo la fecha de fin de seguimiento el 30 de junio de 2013.   mediante un an\u00e1lisis de regresi\u00f3n de cox, se calcul\u00f3 la asociaci\u00f3n entre la puntuaci\u00f3n en las escalas de riesgo, as\u00ed como  entre las distintas variables cl\u00ednicas, ecocardiogr\u00e1ficas y anal\u00edticas de forma individual, con la ocurrencia de los distintos eventos cl\u00ednicos en el seguimiento. Mediante la realizaci\u00f3n de curvas roc, se estudi\u00f3 el valor predictivo de las escalas de riesgo tromboemb\u00f3lico para la ocurrencia de eventos tromboemb\u00f3licos y mortalidad y de la escala has-bled para ocurrencia de sangrado mayor y mortalidad. Posteriormente, se compar\u00f3 el valor predictivo de las escalas de riesgo tromboemb\u00f3lico para tromboembolismo y de las tres escalas para mortalidad (m\u00e9todo de delong).   resultados  durante una mediana de seguimiento de 668 d\u00edas (riq: 293-1186), se registraron los siguientes eventos cl\u00ednicos:  &#8211;\tepisodios tromboemb\u00f3licos:   la incidencia anual de tromboembolismo fue del 2,1%, la incidencia de embolismos en relaci\u00f3n con la cardioversi\u00f3n fue del 0,17%. La mayor parte de los episodios tromboemb\u00f3licos fueron accidentes cerebrovasculares (89,3%). La mortalidad de los episodios tromboemb\u00f3licos fue del  10,7%. En el an\u00e1lisis multivariante, los factores que se asociaron de forma significativa con la aparici\u00f3n de dichos eventos fueron: la edad  65 a\u00f1os (hr: 10,24 (ic95%:1,30-80,48);p=0,02), la insuficiencia hep\u00e1tica severa (hr: 9,7 (ic95%:2,06-45,59);p=0,004), la labilidad en los controles de la anticoagulaci\u00f3n (hr: 3,00 (ic95%:1,16-7,82); p=0,02), la interrupci\u00f3n del tratamiento anticoagulante durante el seguimiento (hr: 5,46 (ic95%:1,94-15,36); p=0,001) y la puntuaci\u00f3n en la escala cha2ds2-vasc (hr:1,44 (ic95%: 1,06-1,94);p=0,01). Aunque las dos escalas de riesgo tromboemb\u00f3lico demostraron poseer valor predictivo de forma significativa para la ocurrencia de estos eventos (estad\u00edstico c para chads2: 0,69 (ic95%:0,64-0,74); p=0,002 y para cha2ds2-vasc: 0,76 (ic95% 0,72-0,80);p&lt;0,001), la escala  cha2ds2-vasc present\u00f3 un valor predictivo superior a la escala chads2 (p=0,004).  &#8211;\tepisodios de sangrado mayor:  la incidencia anual de sangrado mayor fue del 2,0% el origen m\u00e1s frecuente del sangrado mayor fue digestivo (52,3%). La mortalidad de estos episodios de sangrado fue del 17,4%. Los factores individuales que se asociaron de forma significativa con la aparici\u00f3n de dichos eventos fueron: la insuficiencia renal severa (hr: 4,16 (ic95%:1,30-13,27);p=0,01), la labilidad en los controles de la anticoagulaci\u00f3n oral (hr: 3,88 (ic95%:1,11-9,16);p=0,03) y el antecedente de sangrado previo o predisposici\u00f3n al sangrado (hr: 5,07 (ic95%:1,77-14,43);p=0,002). La puntuaci\u00f3n en la escala has-bled mostr\u00f3 asociaci\u00f3n estad\u00edsticamente significativa con la aparici\u00f3n de episodios de sangrado mayor (hr: 1,87 (ic95%:1,35-2,61);p&lt;0,001), poseyendo un buen valor predictivo para la ocurrencia de eventos hemorr\u00e1gicos (estad\u00edstico c: 0,77 (ic95%:0,71-0,83);p&lt;0,001).   &#8211;\tmortalidad: la incidencia anual de mortalidad fue del 2,5%. La mortalidad de la cve fue nula. De forma global, la etiolog\u00eda m\u00e1s frecuente de la muerte fue de origen vascular (54,0%). Los factores que se asociaron de forma significativa con la aparici\u00f3n de mortalidad fueron: la edad (hr: 1,07 (ic95%:1,01-1,45);p=0,04), la labilidad en los controles de la anticoagulaci\u00f3n oral (hr: 3,63 (ic95%:1,06-12,46);p=0,04), el antecedente de sangrado mayor previo o predisposici\u00f3n al sangrado (hr: 8,87 (ic95%:2,46-31,99);p=0,001) y la puntuaci\u00f3n en la escala has-bled (hr: 3,03  (ic95%:1,95-4,87);p&lt;0,001). Aunque las tres escalas demostraron poseer valor predictivo de forma significativa para la ocurrencia de mortalidad (estad\u00edstico c para chads2: 0,69 (ic95%: 0,63-0,75);p=0,001, para  cha2ds2-vasc: 0,71 (ic95%:0,66-0,76);p&lt;0,001 y para has-bled: 0,83 (ic95%: 0,79-0,87);p&lt;0,001), la escala has-bled y la escala cha2ds2-vasc fueron superiores al esquema chads2 en la predicci\u00f3n de la mortalidad, sin diferencias significativas entre ambas (auc de chads2 vs cha2ds2-vasc; p: 0,03, de chads2 vs hasbled; p: 0,04, de cha2ds2 -vasc vs hasbled; p: 0,09).  objectives   the main objectives of this work are:   1. \tStudy the incidence of thromboembolic complications, major bleeding and mortality (short-term and long-term) in patients with non-valvular atrial fibrillation (af) of our environment, who undergo one or more electrical cardioversion (cv) procedures. 2. \tEvaluate the usefulness of the thromboembolic risk scales (chads2 and cha2ds2- vasc) to predict the incidence of thromboembolic events and mortality in our patients. Evaluate the usefulness of the hemorrhagic risk scale has-bled, to predict the incidence of major bleeding and mortality in our patients.   methods   it is a retrospective, descriptive, observational study in which clinical, echocardiographic and analytical data were collected from 406 patients with non-valvular af, undergoing 571 consecutive electrical cv procedures, carried out in the arrhythmia unit of the general university hospital of alicante between january 2008 and june 2012. Chads2, cha2ds2- vasc and has-bled scores were calculated at the time of the inclusion in the study. The incidence of thromboembolic events, major bleeding and death was recorded, being the follow-up end date june 30, 2013.   using a cox regression analysis, we calculated the association between scores on the scales of risk, as well as between the different clinical, echocardiographic and analytic data, with the occurrence of the various clinical events in follow-up. Through the implementation of roc curves, we studied the predictive value of thromboembolic risk scales for the occurrence of thromboembolic events and mortality and of the has-bled scale for occurrence of major bleeding and mortality. Subsequently, we compared the predictive value of the thromboembolic scales for thromboembolic risk and of the three scales for mortality (delong method).  results   during a median follow-up of 668 days (riq: 293-1186), the following clinical events were recorded:     &#8211;\tthromboembolic events:  &#8211;\t the annual incidence of thromboembolism was 2.1%.The incidence of embolism in connection with electrical cv was 0.17%. Most of the thromboembolisms were cerebrovascular accidents (89.3%). The mortality of thomboembolic events was 10.7%. In the multivariate analysis, the factors that were associatedi significantly with the onset of these events were: age  65 (hr: 10.24 (95%ci:1.30-80.48); p = 0.02), severe liver failure (hr: 9.7 (95%ci:2.06-45.59); p = 0, 004), lability in controls of oral anticoagulation (hr: 3, 00 (95%ci:1.16-7.82); p = 0.02), interruption of anticoagulant treatment during follow-up (hr: 5.46 (95%ci1.94-15.36); p = 0.001) and cha2ds2- vasc score (hr: 1.44 (95%ci:1.06-1.94); p =0.01). Although both thromboembolic risk scales demonstrated significant predictive value for the occurrence of thromboembolic events (c statistic for chads2: 0.69 (95%ci:0.64-0.74); p = 0.002 and for cha2ds2- vasc: 0.76 (95%ci:0.72-0.80); p &lt; 0.001)), cha2ds2- vasc scale had a greater predictive value than chads2 (p = 0.004).  &#8211;\tmajor bleeding episodes:  &#8211;\t the annual incidence of major bleeding was 2.0%. The most frequent origin of bleeding was digestive (52.3%). The mortality of these bleeding episodes was 17.4%. Individual factors significantly associated with the occurrence of these events were: severe renal failure (hr: 4.16 (95%ci:1.30-13.27); p = 0.01), lability in controls of oral anticoagulation (hr: 3.88 (95%ci:1.11-9.16); p = 0, 03) and the history of prior bleeding or predisposition to bleeding (hr: 5.07 (95%ci:1.77-14.43); p = 0.002). Has-bled score also showed statistically significant association with the occurrence of major bleeding episodes (hr:1.87 (95%ci:1.35-2.61); p &lt; 0.001), possessing a good predictive value for the occurrence of hemorrhagic events (c statistic: 0.77 (95%ci:0.71-0.83); p &lt; 0.001).  &#8211;\tmortality:  &#8211;\t the annual incidence of mortality was 2.5%. The mortality of the electrical cv procedures was null. Globally, the most frequent etiology of death was of vascular origin (54.0%). The factors that were associated significantly with mortality were: age (hr: 1.07 (95%ci:1.01-1.45); p = 0.04), lability in controls of oral anticoagulation (hr: 3.63 (95%ci:1.06-12.46); p = 0.04), the history of previous major bleeding or diseases with a predisposition to the bleeding (hr: 8.87 (95%ci:2.46-31.99); p = 0.001) and has-bled score (hr: 3.03 (95%ci:1.95-4.87); p &lt; 0.001). Although the three scales proved to have significant predictive value in for the occurrence of mortality (c statistic for chads2. 0.69 (95%ci: 0.63-0.75); p = 0.001; for cha2ds2- vasc: 0.71 (95%ci:0.66-0.76); p &lt; 0.001 and for has-bled: 0.83 (95%ci:0.79-0.87); p &lt; 0.001), has-bled and cha2ds2- vasc schemes were superior to the chads2 scheme in predicting mortality, with no significant differences between the first two (auc de chads2 vs cha2ds2-vasc; p: 0.03, de chads2 vs hasbled; p: 0.04, de cha2ds2 -vasc vs hasbled; p: 0.09).<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>An\u00e1lisis de la incidencia de eventos embolicos, hemorragicos y mortalidad en pacientes con fibrilaci\u00f3n auricular no valvular sometidos a cardioversion electrica de nuestro medio. utilidad de las escalas de riesgo clinicas en la prediccion de la ocurrencia de eventos<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 An\u00e1lisis de la incidencia de eventos embolicos, hemorragicos y mortalidad en pacientes con fibrilaci\u00f3n auricular no valvular sometidos a cardioversion electrica de nuestro medio. utilidad de las escalas de riesgo clinicas en la prediccion de la ocurrencia de eventos <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Amaya Garcia Fernandez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 27\/11\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Vanesa Roldan Schilling<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Mar\u00eda no Valdes chavarri <\/li>\n<li>Manuel Anguita sanchez (vocal)<\/li>\n<li>Francisco Javier Chorro gasc\u00f3 (vocal)<\/li>\n<li>Juan  Miguel Ruiz nodar (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Amaya Garcia Fernandez Objetivos los objetivos principales del presente trabajo son: 1. Conocer la incidencia de las [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[932,8235],"tags":[230301,11531,105035,145485,8243,119966],"class_list":["post-116719","post","type-post","status-publish","format-standard","hentry","category-cardiologia","category-murcia","tag-amaya-garcia-fernandez","tag-francisco-javier-chorro-gasco","tag-juan-miguel-ruiz-nodar","tag-manuel-anguita-sanchez","tag-maria-no-valdes-chavarri","tag-vanesa-roldan-schilling"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116719","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=116719"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116719\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=116719"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=116719"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=116719"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}