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Soluble fibrin monomer complex and prediction of cardiovascular events in atrial fibrillation: the observational Murcia atrial fibrillation project

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dc.contributor.authorRivera Caravaca, José Miguel
dc.contributor.authorRoldán Schilling, Vanessa
dc.contributor.authorRomera, Marta
dc.contributor.authorEsteve-Pastor, María Asunción
dc.contributor.authorValdés Chávarri, Mariano
dc.contributor.authorLip, Gregory YH
dc.contributor.authorVicente García, Vicente
dc.contributor.authorMarín Ortuño, Francisco
dc.contributor.departmentEnfermería
dc.date.accessioned2024-02-07T09:42:32Z
dc.date.available2024-02-07T09:42:32Z
dc.date.issued2018-03-22
dc.description© Society of General Internal Medicine 2018. This document is the Published version of a Published Work that appeared in final form in Journal of General Internal Medicine. To access the final edited and published work see https://doi.org/10.1007/s11606-017-4279-4
dc.description.abstractBACKGROUND: Soluble fibrin monomer complex (SFMC) is a biomarker of fibrin formation abnormally elevated in clinical situations of hypercoagulability. OBJECTIVE: We investigated the association and predictive performance of SFMC for stroke, adverse cardiovascular events, cardiovascular mortality and all-cause mortality in a cohort of patients with atrial fibrillation (AF) receiving vitamin K antagonist (VKA) anticoagulant therapy. DESIGN: During the second semester of 2007, we included 1226 AF outpatients stable on VKAs (INR 2.0–3.0) over a period of 6 months. SFMC levels were assessed at baseline. During 6.5 (IQR 4.4–8.0) years of follow-up, we recorded all ischemic strokes, adverse cardiovascular events (composite of stroke, acute heart failure, acute coronary syndrome and cardiovascular death), cardiovascular deaths and all-cause deaths. PARTICIPANTS: All patients were recruited consecutively. We excluded patients with rheumatic mitral valves, prosthetic heart valves, acute coronary syndrome, stroke, hemodynamic instability, hospital admissions or surgical interventions within the preceding 6 months. MAIN MEASURES: SFMClevelsweremeasured in plasma by immunoturbidimetry in an automated coagulometer (STALiatestFM, Diagnostica Stago, Asnieres, France). KEY RESULTS: We recorded 121 (1.52%/year) ischemic strokes, 257 (3.23%/year) cardiovascular events, 67 (0.84%/year) cardiovascular deaths and 486 (6.10%/year) all-cause deaths. SFMC >12 μg/mL was not associated with stroke but was associated with higher risk of cardiovascular events (HR 1.72, 95% CI 1.31–2.26), cardiovascular mortality (HR 2.16, 95% CI 1.30–3.57) and all-cause mortality (HR 1.26, 95% CI 1.03–1.55). When SFMC >12 μg/mL was added to the CHA2DS2-VASc, there were significant improvements in predictive performance, sensitivity and reclassification for adverse cardiovascular events (c-index: 0.645 vs. 0.660, p = 0.010; IDI = 0.013, p<0.001; NRI=0.121, p<0.001) and cardiovascular mortality (c-index: 0.661 vs. 0.691, p = 0.006; IDI = 0.009, p = 0.049; NRI = 0.217, p < 0.001), but decision curves demonstrated a similar net benefit and clinical usefulness. CONCLUSIONS: In AF patients taking VKAs, high SFMC levels were associated with the risk of adverse cardiovascular events, cardiovascular mortality and all-cause mortality. The addition of SFMC to the CHA2DS2-VASc score improved its predictive performance for these outcomes, but failed to show an improvement in clinical usefulness.es
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dc.identifier.citationJournal of General Internal Medicine, 2018; 33(6):847–54
dc.identifier.doihttps://doi.org/10.1007/s11606-017-4279-4
dc.identifier.urihttp://hdl.handle.net/10201/138864
dc.languageenges
dc.publisherSpringer
dc.relationInstituto de Salud Carlos III (ISCIII), Fondo Europeo de Desarrollo Regional (FEDER) (PI13/00513 y P14/00253), Fundación Séneca (19245/PI/14) e Instituto Murciano de Investigación Biosanitaria (IMIB16/AP/01/06).es
dc.relation.publisherversionhttps://link.springer.com/article/10.1007/s11606-017-4279-4
dc.rights.accessRightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectFibrilación auriculares
dc.subjectAnticoagulanteses
dc.subjectMonómeros de fibrinaes
dc.subjectBiomarcadoreses
dc.subjectTrombosises
dc.subjectMortalidades
dc.subject.otherCDU::6 - Ciencias aplicadas::61 - Medicinaes
dc.titleSoluble fibrin monomer complex and prediction of cardiovascular events in atrial fibrillation: the observational Murcia atrial fibrillation projectes
dc.typeinfo:eu-repo/semantics/articlees
dspace.entity.typePublicationes
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