Cierre de orejuela izquierda frente a ACOD en pacientes mayores: análisis con emparejamiento por puntuación de propensión

  1. Berenice Caneiro Queija 1
  2. Rodrigo Estévez Loureiro 1
  3. Sergio Raposeiras Roubín 1
  4. Emad Abu Assi 1
  5. Rocío González Ferreiro 1
  6. Ignacio Cruz González 2
  7. Alejandro Diego Nieto 2
  8. Antonio de Miguel Castro 1
  9. Guillermo Bastos Fernández 1
  10. José A. Baz Alonso 1
  11. Guilles O’Hara 3
  12. Josep Rodés-Cabau 3
  13. A. Íñiguez Romo 1
  1. 1 Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
  2. 2 Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
  3. 3 Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canadá
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Revista:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Año de publicación: 2022

Volumen: 4

Número: 4

Páginas: 304-310

Tipo: Artículo

DOI: 10.24875/RECIC.M22000316 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: REC: Interventional Cardiology

Resumen

Introducción y objetivos: Existe poca información comparativa entre el cierre de la orejuela izquierda (COI) y los anticoagulantes orales de acción directa (ACOD). Nuestro objetivo fue comparar los resultados clínicos entre el COI y los ACOD en una población de pacientes mayores de 80 años. Métodos: Se analizaron 1.144 pacientes octogenarios con fibrilación auricular provenientes de 3 hospitales terciarios. De ellos, 970 recibían ACOD y 174 fueron sometidos a COI. Ambos grupos presentaban similares factores de riesgo cardiovascular. El grupo de COI tenía mayor porcentaje de antecedentes de hemorragia, anemia y cáncer previo. Se llevó a cabo un análisis emparejado y se obtuvieron 2 grupos de 58 pacientes con similares factores de riesgo, comorbilidad y escalas de riesgo que fueron sometidos a COI o recibían tratamiento con ACOD. Los resultados de acuerdo con la estrategia terapéutica se obtuvieron mediante regresión de Cox. Resultados: Durante una mediana de seguimiento de 2 años [rango: 0,9-3,5] no hubo diferencias en cuanto al evento combinado primario de muerte, hemorragia mayor o ictus (HR = 1,05; IC95%, 0,15-7,51). Las hemorragias fueron similares en ambos grupos, sin diferencias estadísticamente significativas (HR = 1,79; IC95%, 0,73-4,41). La mortalidad fue mayor en los pacientes con ACOD (31,8%) frente a aquellos con COI (26,4%), sin diferencias significativas (HR = 0,70; IC95%, 0,33-1,47). Conclusiones: En comparación con los ACOD, el COI no ha mostrado diferencias en cuanto a eventos embólicos, hemorragias y mortalidad en una población de pacientes de edad avanzada. En nuestra cohorte, el COI es una alternativa que puede considerarse para los pacientes mayores de 80 años.

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Fuente de los datos: Dialnet