Tzikas Apostolos, Freixa Xavier, Llull Laura, Gafoor Sameer, Shakir Samera, Omran Heyder, Giannakoulas George, Berti Sergio, Santoro Gennaro, Kefer Joelle, Aminian Adel, Gloekler Steffen, Landmesser Ulf, Nielsen-Kudsk Jens Erik, Cruz-Gonzalez Ignacio, Kanagaratnam Prapa, Nietlispach Fabian, Ibrahim Reda, Sievert Horst, Schillinger Wolfgang, Park Jai-Wun, Meier Bernhard, Karvounis Haralampos
AHEPA University Hospital, Thessaloniki, Greece.
Hospital Clinic of University of Barcelona, Barcelona, Spain.
Int J Cardiol. 2017 Jun 1;236:232-236. doi: 10.1016/j.ijcard.2017.02.042. Epub 2017 Feb 13.
In patients with non-valvular atrial fibrillation (NVAF), intracranial bleeding (ICB) constitutes a very challenging situation in which the rate of both ischemic and hemorrhagic events is increased. In these patients, left atrial appendage occlusion (LAAO) might represent a very valid alternative.
To investigate the procedural safety and long-term outcome of patients undergoing LAAO therapy due to previous ICB.
Data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients were analyzed. Patients with previous ICB as indication for LAAO were compared to patients with other indications.
A total of 198 patients (18.9%) with previous ICB were identified. The CHADS-VASc score was similar (4.5±1.5 vs. 4.4±1.6, p=0.687) and the HAS-BLED score was higher in patients with previous ICB compared to those without (3.5±1.1 vs. 3.1±1.2, p<0.001). No significant differences in peri-procedural major adverse events were observed (2.5 vs 5.4%, p=0.1). Patients with previous ICB were more frequently on single acetylsalicylic acid therapy after LAAO (42.4% vs. 28.3%; p<0.001). With an average follow-up of 1.3years, the observed annual stroke/TIA rate (procedure and follow-up) for patients with previous ICB was 1.4% (75% relative risk reduction). The observed annual major bleeding rate (procedure and follow-up) for patients with previous ICB was 0.7% (89% relative risk reduction).
In patients with NVAF and previous ICB, LAAO seemed to be a safe procedure and was associated with a significant reduction in stroke/TIA and a remarkably low frequency of major bleeding during follow-up.
在非瓣膜性心房颤动（NVAF）患者中，颅内出血（ICB）是一种极具挑战性的情况，缺血性和出血性事件的发生率均会增加。在这些患者中，左心耳封堵术（LAAO）可能是一种非常有效的替代方案。
研究因既往颅内出血而接受左心耳封堵术治疗的患者的手术安全性和长期预后。
分析了来自Amplatzer心脏封堵器多中心注册研究的1047例连续患者的数据。将因既往颅内出血作为左心耳封堵术指征的患者与其他指征的患者进行比较。
共识别出198例（18.9%）既往有颅内出血的患者。既往有颅内出血的患者的CHADS-VASc评分相似（4.5±1.5对4.4±1.6，p = 0.687），但与无既往颅内出血的患者相比，其HAS-BLED评分更高（3.5±1.1对3.1±1.2，p<0.001）。围手术期主要不良事件未观察到显著差异（2.5%对5.4%，p = 0.1）。既往有颅内出血的患者在左心耳封堵术后更频繁地接受单一阿司匹林治疗（42.4%对28.3%；p<0.001）。平均随访1.3年，既往有颅内出血的患者观察到的年度卒中/短暂性脑缺血发作率（手术和随访期间）为1.4%（相对风险降低75%）。既往有颅内出血的患者观察到的年度主要出血率（手术和随访期间）为0.7%（相对风险降低89%）。
在非瓣膜性心房颤动且既往有颅内出血的患者中，左心耳封堵术似乎是一种安全的手术，与随访期间卒中/短暂性脑缺血发作的显著减少以及极低的主要出血频率相关。
