Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion

Background: Patients with nonvalvular atrial fibrillation (AF) who undergo electrical cardioversion (ECV) tend to be younger and have less comorbidity. Long-term anticoagulation after ECV should be based on thromboembolic risk. We sought to study the long-term incidence of thromboembolic events (TE)...

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Autores: Garcia-Fernandez, Amaya, Marin, Francisco, Roldan, Vanessa, Gomez-Sansano, Jose M., Hernandez-Romero, Diana, Valdes, Mariano, Martinez-Martinez, Juan G., Sogorb-Garri, Francisco, Lip, Gregory Y. H.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p7344
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones7344
Access Level:acceso abierto
Palabra clave:Anticoagulants
Atrial fibrillation
Cardioversion
Risk factors
Thromboembolism
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spelling Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical CardioversionGarcia-Fernandez, AmayaMarin, FranciscoRoldan, VanessaGomez-Sansano, Jose M.Hernandez-Romero, DianaValdes, MarianoMartinez-Martinez, Juan G.Sogorb-Garri, FranciscoLip, Gregory Y. H.AnticoagulantsAtrial fibrillationCardioversionRisk factorsThromboembolismBackground: Patients with nonvalvular atrial fibrillation (AF) who undergo electrical cardioversion (ECV) tend to be younger and have less comorbidity. Long-term anticoagulation after ECV should be based on thromboembolic risk. We sought to study the long-term incidence of thromboembolic events (TE), factors related to TE and compare the predictive value of the CHADS(2) and CHA(2)DS(2)-VASc scores in this particular population. Methods and Results: From January 2008 to June 2012, 571 ECV were performed in 406 consecutive patients with nonvalvular AF. Risk factors for TE and factors related to anticoagulation therapy after ECV were registered. During a follow-up of approximately 2 years, the annual incidence of TE was 1.9%. Factors associated with TE were: poor quality anticoagulation control (hazard ratio [HR]: 2.91; 95% confidence interval [CI]: 1.10-7.80; P=0.03), cessation of anticoagulation after ECV (HR: 8.80; 95% CI: 3.11-25.10; P<0.001), age >= 65 years (HR: 13.65; 95% CI: 1.74-107.16; P=0.01), CHADS(2) score (HR: 1.59; 95% CI: 1.10-2.29; P=0.01) and CHA(2)DS(2)-VASc score (HR: 1.67; 95% CI: 1.30-2.22; P<0.001). Both risk scores predicted TE [c-statistic for CHADS(2): 0.68 (95% CI: 0.62-0.74; P=0.005), for CHA(2)DS(2)-VASc: 0.75 (95% CI: 0.70-0.80; P<0.001)]. Based on c-statistics, the predictive accuracy of CHA(2)DS(2)-VASc was superior (difference between areas: 0.064+/-0.031; P=0.0403). Conclusions: Important determinants of long-term occurrence of TE after ECV were related to anticoagulant therapy (poor quality anticoagulation and cessation of this therapy over follow-up). The CHA(2)DS(2)-VASc score successfully predicts TE after ECV, having better predictive accuracy than the CHADS(2) score.JAPANESE CIRCULATION SOC2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones7344CIRCULATION JOURNALISSN: 13469843ISSNe: 13474820reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Inglésinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p73442026-06-12T10:20:37Z
dc.title.none.fl_str_mv Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
title Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
spellingShingle Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
Garcia-Fernandez, Amaya
Anticoagulants
Atrial fibrillation
Cardioversion
Risk factors
Thromboembolism
title_short Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
title_full Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
title_fullStr Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
title_full_unstemmed Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
title_sort Long-Term Predictors of Thromboembolic Events in Nonvalvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion
dc.creator.none.fl_str_mv Garcia-Fernandez, Amaya
Marin, Francisco
Roldan, Vanessa
Gomez-Sansano, Jose M.
Hernandez-Romero, Diana
Valdes, Mariano
Martinez-Martinez, Juan G.
Sogorb-Garri, Francisco
Lip, Gregory Y. H.
author Garcia-Fernandez, Amaya
author_facet Garcia-Fernandez, Amaya
Marin, Francisco
Roldan, Vanessa
Gomez-Sansano, Jose M.
Hernandez-Romero, Diana
Valdes, Mariano
Martinez-Martinez, Juan G.
Sogorb-Garri, Francisco
Lip, Gregory Y. H.
author_role author
author2 Marin, Francisco
Roldan, Vanessa
Gomez-Sansano, Jose M.
Hernandez-Romero, Diana
Valdes, Mariano
Martinez-Martinez, Juan G.
Sogorb-Garri, Francisco
Lip, Gregory Y. H.
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Anticoagulants
Atrial fibrillation
Cardioversion
Risk factors
Thromboembolism
topic Anticoagulants
Atrial fibrillation
Cardioversion
Risk factors
Thromboembolism
description Background: Patients with nonvalvular atrial fibrillation (AF) who undergo electrical cardioversion (ECV) tend to be younger and have less comorbidity. Long-term anticoagulation after ECV should be based on thromboembolic risk. We sought to study the long-term incidence of thromboembolic events (TE), factors related to TE and compare the predictive value of the CHADS(2) and CHA(2)DS(2)-VASc scores in this particular population. Methods and Results: From January 2008 to June 2012, 571 ECV were performed in 406 consecutive patients with nonvalvular AF. Risk factors for TE and factors related to anticoagulation therapy after ECV were registered. During a follow-up of approximately 2 years, the annual incidence of TE was 1.9%. Factors associated with TE were: poor quality anticoagulation control (hazard ratio [HR]: 2.91; 95% confidence interval [CI]: 1.10-7.80; P=0.03), cessation of anticoagulation after ECV (HR: 8.80; 95% CI: 3.11-25.10; P<0.001), age >= 65 years (HR: 13.65; 95% CI: 1.74-107.16; P=0.01), CHADS(2) score (HR: 1.59; 95% CI: 1.10-2.29; P=0.01) and CHA(2)DS(2)-VASc score (HR: 1.67; 95% CI: 1.30-2.22; P<0.001). Both risk scores predicted TE [c-statistic for CHADS(2): 0.68 (95% CI: 0.62-0.74; P=0.005), for CHA(2)DS(2)-VASc: 0.75 (95% CI: 0.70-0.80; P<0.001)]. Based on c-statistics, the predictive accuracy of CHA(2)DS(2)-VASc was superior (difference between areas: 0.064+/-0.031; P=0.0403). Conclusions: Important determinants of long-term occurrence of TE after ECV were related to anticoagulant therapy (poor quality anticoagulation and cessation of this therapy over follow-up). The CHA(2)DS(2)-VASc score successfully predicts TE after ECV, having better predictive accuracy than the CHADS(2) score.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones7344
url https://isabial.portalinvestigacion.com/publicaciones7344
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv JAPANESE CIRCULATION SOC
publisher.none.fl_str_mv JAPANESE CIRCULATION SOC
dc.source.none.fl_str_mv CIRCULATION JOURNAL
ISSN: 13469843
ISSNe: 13474820
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
repository.name.fl_str_mv
repository.mail.fl_str_mv
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