Accidente cerebrovascular en adultos con enfermedad cardíaca congénita: incidencia, riesgo acumulado y factores predictivos

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Jonas Lanz¹, James M Brophy¹, Judith Therrien¹

¹From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).

|November 25, 2015

Resumen

Los pacientes adultos con enfermedades cardíacas congénitas enfrentan un riesgo significativamente mayor de accidente cerebrovascular, con 1 de cada 11 hombres y 1 de cada 15 mujeres experimentando accidentes cerebrovasculares a los 64 años. Los principales predictores incluyen insuficiencia cardíaca, diabetes e infarto de miocardio reciente.

Área de la Ciencia:

Cardiología
Neurología
Salud pública

Sus antecedentes:

El accidente cerebrovascular es una de las principales causas de muerte y discapacidad.
Los datos completos sobre la incidencia, el riesgo y los predictores de ictus en pacientes adultos con enfermedad cardíaca congénita (ACHD) son limitados.
El ACHD es una población en crecimiento que requiere datos específicos de resultados de salud.

Objetivo del estudio:

Determinar la incidencia, el riesgo acumulado y los factores predictivos de accidente cerebrovascular en pacientes con ACHD.
Comparar las tasas de accidentes cerebrovasculares en pacientes con EAC con la población general.
Identificar los principales factores de riesgo para el ictus en esta población vulnerable.

Principales métodos:

Estudio retrospectivo de 29.638 pacientes con EACH de entre 18 y 64 años en Quebec (1998-2010).
Se utilizaron datos administrativos de toda la provincia para el análisis.
Empleado la selección del modelo por etapas y el promedio del modelo bayesiano para identificar predictores.

Principales resultados:

El riesgo acumulado de accidente cerebrovascular a la edad de 64 años fue del 6,1% para las mujeres y del 7,7% para los hombres.
La incidencia de ictus isquémico fue de 9 a 12 veces mayor en pacientes con EACH menores de 55 años en comparación con la población general.
La insuficiencia cardíaca, la diabetes mellitus y el infarto de miocardio reciente fueron los predictores más fuertes del accidente cerebrovascular isquémico.

Conclusiones:

La incidencia de accidentes cerebrovasculares es sustancialmente elevada en pacientes con ACHD, especialmente en edades más jóvenes.
1 de cada 11 hombres y 1 de cada 15 mujeres con ACHD experimentaron un accidente cerebrovascular entre las edades de 18 y 64 años.
Se necesitan más investigaciones para reducir las tasas de accidente cerebrovascular en ACHD a través de un mejor manejo.

Palabras clave:

Congénito Ciencias de la salud defectos del corazón Incidencia de la enfermedad Factores de riesgo el golpe

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