RT info:eu-repo/semantics/doctoralThesis
T1 Evaluación de síndromes cardiovasculares agudos en urgencias: factores de riesgo de mortalidad, diagnóstico y uso de biomarcadores POCT
A1 Zalama Sánchez, Daniel
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Cardiología
K1 Cardiovascular diseases
K1 Enfermedades cardiovasculares
K1 Biomarkers
K1 Biomarcadores
K1 Point-of-care testing
K1 Pruebas en punto de atención
K1 Emergency Medicine
K1 Medicina de Urgencias
K1 32 Ciencias Médicas
AB Acute cardiovascular diseases are among the leading causes of morbidity and mortality worldwide and a constant challenge for prehospital and hospital emergency systems. Rapid identification of at-risk patients and proper management of time-dependent pathologies are essential to improve clinical outcomes. In this context, the use of biomarkers and point-of-care testing (POCT) diagnostic tools has emerged as a key strategy, especially in critical situations such as acute coronary syndrome (ACS).The main objective of this thesis was to optimize the care of acute cardiovascular diseases in emergency settings by analyzing risk factors, developing predictive models based on biomarkers, and evaluating POCT diagnostic devices. To this end, three prospective multicenter studies were conducted, analyzing different aspects of these pathologies.The first study identified prehospital factors associated with short- and long-term mortality in patients attended by emergency medical services. The results revealed that advanced age (≥75 years) and specific prehospital interventions, such as mechanical ventilation and cardioversion, are associated with an increased risk of mortality.The second study developed a scoring model based on cardiac biomarkers (cTnT, NT-proBNP, and D-dimer) to predict one-year mortality in patients with acute chest pain. This model demonstrated high predictive capacity, surpassing the performance of individually assessed biomarkers and facilitating risk stratification in the prehospital setting.Finally, the third study evaluated the diagnostic performance of a POCT high-sensitivity troponin device (hs-cTn Siemens Atellica® VTLi) in the context of suspected ACS. It was concluded that the device is comparable to central laboratory testing in terms of diagnostic accuracy. Moreover, its use significantly reduces the time to obtain results, optimizing clinical management in emergency settings.Overall, this work highlights the importance of integrating biomarkers, predictive models, and POCT technology to improve the diagnosis and management of acute cardiovascular diseases. These advances not only contribute to more efficient and personalized care but also optimize the use of resources in emergency services.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76136
UL https://uvadoc.uva.es/handle/10324/76136
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 05-jul-2025