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El embarazo y el riesgo de disección o ruptura aórtica: un análisis de cohortes cruzados
Hooman Kamel1, Mary J Roman2, Alex Pitcher2
1From Department of Neurology (H.K.), Feil Family Brain and Mind Research Institute (H.K.), and Division of Cardiology M.J.R., R.B.D.), Weill Cornell Medicine, New York, NY; and Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK (A.P.). hok9010@med.cornell.edu.
Circulation
|August 6, 2016
Resumen
El embarazo aumenta significativamente el riesgo de disección o ruptura aórtica. Este estudio encontró un riesgo cuatro veces mayor durante el embarazo y el posparto en comparación con un año después, destacando un período crítico para eventos cardiovasculares.
Área de la Ciencia:
- Salud cardiovascular
- Obstetricia y ginecología
- Investigación en salud pública
Sus antecedentes:
- La disección y ruptura de la aorta en el embarazo se documentan en series de casos.
- Existen datos limitados basados en la población para confirmar una asociación entre el embarazo y las complicaciones aórticas.
Objetivo del estudio:
- Investigar la asociación entre el embarazo y el riesgo de disección o ruptura aórtica.
- Cuantificar el riesgo de estos eventos aórticos durante el embarazo y el período posparto.
Principales métodos:
- Se utilizó un diseño de estudio de cohorte cruzado utilizando datos de atención médica a gran escala de tres estados de los Estados Unidos.
- Se incluyeron mujeres de 12 años o más con resultados de embarazo (2005-2013).
- Se evaluó un resultado compuesto de disección o ruptura aórtica durante un período de riesgo de 6 meses antes del parto a 3 meses después del parto, en comparación con un período de control un año después.
Principales resultados:
- Se analizaron más de 6,5 millones de embarazos, identificando 36 casos de disección/ruptura aórtica durante el período de riesgo y 9 durante el período de control.
- La tasa de complicaciones aórticas fue de 5,5 por millón durante el embarazo/postparto frente a 1,4 por millón en el período de control.
- El embarazo se asoció con un riesgo significativamente mayor (IRR 4,0; IC del 95% 2,0- 8,2).
Conclusiones:
- El riesgo de disección o ruptura aórtica es sustancialmente elevado durante el embarazo y el período posparto.
- Este mayor riesgo subraya la importancia de la monitorización cardiovascular en las personas embarazadas y posparto.
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