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https://doi.org/10.1161/STROKEAHA.118.024305
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Título: | Refining stroke and bleeding prediction in atrial fibrillation by adding consecutive biomarkers to clinical risk scores |
Fecha de publicación: | 2019 |
Cita bibliográfica: | Stroke. 2019;50:1372-1379 |
ISSN: | Print: 0039-2499 Electronic: 1524-4628 |
Materias relacionadas: | CDU::6 - Ciencias aplicadas::61 - Medicina |
Palabras clave: | Fibrilación auricular Biomarcadores Hemorragia Evaluación del riesgo Ictus Atrial fibrillation Biomarkers Hemorrhage Risk assessment Stroke |
Resumen: | Background and Purpose: Current European guidelines for the management of atrial fibrillation suggest using biomarkers to refine the risk stratification process. However, it is unclear whether ≥2 biomarkers incrementally improve risk prediction beyond 1 biomarker alone. We investigated whether the predictive performance of CHA2DS2-VASc and HASBLED scores could be enhanced by incrementally adding consecutive different biomarkers in real-world atrial fibrillation patients taking vitamin K antagonists therapy. Methods: We included 940 atrial fibrillation patients stable on vitamin K antagonists (international normalized ratio, 2.0–3.0) for at least the previous 6 months. At inclusion, VWF (von Willebrand factor), high-sensitivity troponin T, NTproBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity IL (interleukin)-6, fibrin monomers, and BTP (β-trace protein) concentrations were quantified. During follow-up, all adverse events were recorded, and biomarkers were added to CHA2DS2-VASc and HAS-BLED scores depending on the C index. Results: During 6.5 (4.3–7.9) years, there were 98 ischemic strokes (1.60% per year) and 172 major bleeds (1.60% per year). After the addition of biomarkers, the predictive performance of CHA2DS2-VASc was not significantly increased, although the model with 3 biomarkers (ie, NT-proBNP+BTP+VWF) showed a low gain in sensitivity (integrated discrimination improvement, 2.70%; P<0.001). The predictive performance of HAS-BLED was enhanced in all biomarker-based models, with the best prediction shown by the model with 3 biomarkers (ie, VWF+NT-proBNP+high-sensitivity IL-6; C index, 0.600 [95% CI, 0.561–0.625] versus 0.639 [95% CI, 0.607–0.669]; P=0.025). This model also confirmed an increased sensitivity (integrated discrimination improvement, 5.20%; P<0.001) and positive reclassification (net reclassification improvement, 19.20%; P=0.020). Conclusions: By adding consecutive biomarkers, the predictive ability of CHA2DS2-VASc for ischemic stroke was not increased, whereas the predictive ability of HAS-BLED for major bleeding was only slightly enhanced. The net benefit and clinical usefulness of the biomarker-based models were marginal in comparison to the original scores based on clinical factors. |
Autor/es principal/es: | Rivera Caravaca, José Miguel Marín Ortuño, Francisco Vílchez Aguilera, Juan Antonio Gálvez, Josefa Esteve-Pastor, María Asunción Vicente García, Vicente Lip, Gregory YH Roldán Schilling, Vanessa |
Facultad/Departamentos/Servicios: | Facultades, Departamentos, Servicios y Escuelas::Departamentos de la UMU::Enfermería |
URI: | http://hdl.handle.net/10201/138841 |
DOI: | https://doi.org/10.1161/STROKEAHA.118.024305 |
Tipo de documento: | info:eu-repo/semantics/article |
Número páginas / Extensión: | 8 |
Derechos: | info:eu-repo/semantics/embargoedAccess Attribution-NonCommercial-NoDerivatives 4.0 Internacional |
Descripción: | Acceso restringido |
Aparece en las colecciones: | Artículos: Enfermería |
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Fichero | Descripción | Tamaño | Formato | |
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Refining Stroke and Bleeding Prediction in Atrial.pdf | 457,51 kB | Adobe PDF | Visualizar/Abrir Solicitar una copia |
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