Prevalence and Prognostic Implications of Valve Disease in Patients With Atrial Fibrillation Initiating Direct Oral Anticoagulants.
Por:
Caro Martínez C, Elvira Ruiz G, Flores Blanco PJ, Cerezo Manchado JJ, Albendín Iglesias H, Lova Navarro A, Arregui Montoya F, García Alberola A, Pascual Figal DA, Bailén Lorenzo JL and Manzano Fernández S
Publicada:
26 nov 2018
Ahead of Print:
26 nov 2018
Categoría:
Medicine (miscellaneous)
Resumen:
INTRODUCTION AND OBJECTIVES: Valvular heart disease in patients with
atrial fibrillation included in clinical trials with direct oral
anticoagulants (DOAC) is common and is associated with worse prognosis.
The aim of this study was to evaluate the prevalence of valvular heart
disease and its influence on clinical events in real-world clinical
practice.
METHODS: We conducted a retrospective multicenter registry including
2297 consecutive patients with nonvalvular atrial fibrillation
initiating DOAC between January 2013 and December 2016. Valvular heart
disease was defined as moderate or severe involvement. The primary study
endopoint was the composite of death, stroke or transient ischemic
attack/systemic embolism or major bleeding. A competing risks analysis
was carried out using a Fine and Gray regression model, with death being
the competing event.
RESULTS: A total of 499 (21.7%) patients had significant valvular heart
disease. The most common form was mitral regurgitation (13.7%). Patients
with valvular heart disease were older and had more comorbidities. After
multivariable analysis, valvular heart disease was associated with a
higher risk for the primary endpoint (HR, 1.54; 95%CI, 1.22-1.94;
P<.001), death (HR, 1.44; 95%CI, 1.09-1.91, P=.010), and major bleeding
(HR, 1.85; 95%CI, 1.23-2.79, P=.003), but there was no association with
thromboembolic events (P >.05).
CONCLUSIONS: In patients with nonvalvular atrial fibrillation initiating
DOACs, valvular heart disease is common and increases the risk of
mortality, stroke, transient ischemic attack/systemic embolism, and
major bleeding complications. These findings confirm the results of
clinical trials and expand them to a real-life clinical setting.
Filiaciones:
Caro Martínez C:
Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Elvira Ruiz G:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Flores Blanco PJ:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Cerezo Manchado JJ:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Albendín Iglesias H:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Lova Navarro A:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Arregui Montoya F:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
García Alberola A:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Pascual Figal DA:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
:
Servicio de Cardiología, Hospital Vega Baja, Orihuela, Alicante, Spain
Manzano Fernández S:
Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
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