Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation.

Häner, Jonas D.; Fürholz, Monika; Kleinecke, Caroline; Galea, Roberto; Streit, Samuel R.; Fankhauser, Mate; Cherni, Takwa; Valgimigli, Marco; Windecker, Stephan; Meier, Bernhard; Gloekler, Steffen (2021). Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation. Catheterization and cardiovascular interventions, 97(7), E1002-E1010. Wiley-Blackwell 10.1002/ccd.29318

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OBJECTIVES

To investigate periprocedural and long-term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre-procedural stroke risk.

BACKGROUND

LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre-procedural stroke risk may affect procedural and long-term clinical outcome after LAAC is unclear.

METHODS

Multicenter study of consecutive patients who underwent Amplatzer-LAAC. Using pre-procedural CHADS2 score, outcomes were compared between a low (0-2 points) and a high stroke risk group (3-6 points).

RESULTS

Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer-LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low-risk group) and the remaining 252 patients had 3-6 points (high-risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device-related complications or major para-device leaks: 89.4% vs. 87.9%, p = .74), and 30-day-mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient-years (PY), the long-term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%-CI, 1.28-3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life-threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%-CI, 0.66-2.20, p = .52).

CONCLUSIONS

Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high-risk patients in our study.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Häner, Jonas; Fürholz, Monika; Valgimigli, Marco and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1522-1946

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jonas Häner

Date Deposited:

08 Sep 2021 07:35

Last Modified:

08 Sep 2021 07:35

Publisher DOI:

10.1002/ccd.29318

PubMed ID:

33022121

Uncontrolled Keywords:

LAA closure antithrombotic treatment atrial fibrillation bleeding risk stratification stroke

URI:

https://boris.unibe.ch/id/eprint/158964

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