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Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication.
Aarnink, Errol W; Maarse, Moniek; Fierro, Nicolai; Mazzone, Patrizio; Beneduce, Alessandro; Tondo, Claudio; Gasperetti, Alessio; Pracon, Radoslaw; Demkow, Marcin; Zielinski, Kamil; de Backer, Ole; Korsholm, Kasper; Nielsen-Kudsk, Jens Erik; Estévez-Loureiro, Rodrigo; Caneiro-Queija, Berenice; Benito-González, Tomás; Pérez de Prado, Armando; Nombela-Franco, Luis; Salinas, Pablo; Holmes, David; Almakadma, Abdul H; Berti, Sergio; Romeo, Maria Rita; Millan, Xavier; Arzamendi, Dabit; Alla, Venkata M; Agarwal, Himanshu; Eitel, Ingo; Paitazoglou, Christina; Freixa, Xavier; Cepas-Guillén, Pedro; Chothia, Rashaad; Badejoko, Solomon O; Spoon, Daniel B; Maddux, James T; El-Chami, Mikhael; Ram, Pradhum; Branca, Luca; Adamo, Marianna; Suradi, Hussam S; Peper, Joyce; van Dijk, Vincent F; Rensing, Benno J W M; Swaans, Martin J; Vireca, Elisa; Bergmann, Martin W; Boersma, Lucas V A.
Afiliación
  • Aarnink EW; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands; Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands. Electronic address: e.aarnink@antoniusziekenhuis.nl.
  • Maarse M; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands; Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
  • Fierro N; De Gasperis Cardio Center, Interventional Cardiology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Mazzone P; Arrhythmia Unit and Electrophysiology Laboratories, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Beneduce A; IRCCS, San Raffaele Scientific Institute, Milan, Italy.
  • Tondo C; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, Instituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
  • Gasperetti A; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, Instituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
  • Pracon R; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland.
  • Demkow M; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland.
  • Zielinski K; Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland.
  • de Backer O; Heart Center, Rigshospitalet, Copenhagen, Denmark.
  • Korsholm K; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  • Nielsen-Kudsk JE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  • Estévez-Loureiro R; Interventional Cardiology Unit, University Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Caneiro-Queija B; Interventional Cardiology Unit, University Hospital Álvaro Cunqueiro, Vigo, Spain.
  • Benito-González T; Department of Cardiology, University Hospital of León, León, Spain.
  • Pérez de Prado A; Department of Cardiology, University Hospital of León, León, Spain.
  • Nombela-Franco L; Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
  • Salinas P; Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
  • Holmes D; Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
  • Almakadma AH; Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
  • Berti S; Fondazione Toscana "G. Monasterio," Massa, Italy.
  • Romeo MR; Fondazione Toscana "G. Monasterio," Massa, Italy.
  • Millan X; Cardiology Department, Sant Pau Research Institute, Barcelona, Spain.
  • Arzamendi D; Cardiology Department, Sant Pau Research Institute, Barcelona, Spain.
  • Alla VM; Creighton University School of Medicine, Omaha, Nebraska, USA.
  • Agarwal H; Creighton University School of Medicine, Omaha, Nebraska, USA.
  • Eitel I; Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
  • Paitazoglou C; Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
  • Freixa X; Department of Cardiology, Institut Clinic Cardiovascular, Hospital Clínic of Barcelona, Barcelona, Spain.
  • Cepas-Guillén P; Department of Cardiology, Institut Clinic Cardiovascular, Hospital Clínic of Barcelona, Barcelona, Spain.
  • Chothia R; St. Joseph's Medical Center, Stockton, California, USA.
  • Badejoko SO; St. Joseph's Medical Center, Stockton, California, USA.
  • Spoon DB; Department of Cardiology, Providence Heart Institute, Missoula, Montana, USA.
  • Maddux JT; Department of Cardiology, Providence Heart Institute, Missoula, Montana, USA.
  • El-Chami M; Department of Cardiology, Emory University Hospital, Atlanta, Georgia, USA.
  • Ram P; Department of Cardiology, Emory University Hospital, Atlanta, Georgia, USA.
  • Branca L; Cardiology and Cardiac Catheterization Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Adamo M; Cardiology and Cardiac Catheterization Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Suradi HS; Division of Cardiovascular Medicine, Rush University Medical Center, Chicago, Illinois, USA.
  • Peper J; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
  • van Dijk VF; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
  • Rensing BJWM; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
  • Swaans MJ; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
  • Vireca E; Boston Scientific, Diegem, Belgium.
  • Bergmann MW; Department of Cardiology, Asklepios Klinik Altona, Hamburg, Germany.
  • Boersma LVA; Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands; Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
JACC Cardiovasc Interv ; 17(11): 1311-1321, 2024 Jun 10.
Article en En | MEDLINE | ID: mdl-38795093
ABSTRACT

BACKGROUND:

Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also benefit from LAAO.

OBJECTIVES:

This study sought to investigate the efficacy of LAAO in AF patients with a thrombotic event on OAT compared to 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data.

METHODS:

The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores.

RESULTS:

Analysis of 438 matched pairs revealed no significant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR 1.37; 95% CI 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR 1.71; 95% CI 1.04-2.83) but lower bleeding risk (HR 0.39; 95% CI 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log-rank P = 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT.

CONCLUSIONS:

LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the OAT contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reflecting the intrinsically different risk profile of both populations. Until randomized trials are available, LAAO may be considered in patients with an ischemic event on OAT.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Cateterismo Cardíaco / Sistema de Registros / Apéndice Atrial / Contraindicaciones de los Medicamentos / Accidente Cerebrovascular Isquémico / Anticoagulantes Límite: Aged80 País/Región como asunto: Europa Idioma: En Revista: JACC Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Cateterismo Cardíaco / Sistema de Registros / Apéndice Atrial / Contraindicaciones de los Medicamentos / Accidente Cerebrovascular Isquémico / Anticoagulantes Límite: Aged80 País/Región como asunto: Europa Idioma: En Revista: JACC Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos