Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
EuroIntervention. 2017 Jun 20;13(3):371-378. doi: 10.4244/EIJ-D-17-00201.
The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy.
A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the AMPLATZER Cardiac Plug or the AMPLATZER AMULET were compared to a propensity score-matched group of 151 patients receiving standard medical therapy. The two groups were matched so that their risks for stroke and bleeding were similar (CHA2DS2-VASc and HAS-BLED scores). The standard care patients were identified from the Danish Stroke Registry among 787 patients with AF and ICH. The primary endpoint was a composite of all-cause mortality, ischaemic stroke and major bleeding. Patients with AF and a prior ICH treated with LAAO had a lower risk of the composite outcome as compared to patients treated with standard medical care (events/1,000 years [95% confidence interval]: 53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]; hazard ratio 0.16 [0.07-0.37]).
LAAO is suggested to be of major clinical benefit in AF patients having sustained an ICH. These results have to be confirmed in a randomised clinical trial.
本研究旨在探讨与接受标准药物治疗的患者相比，接受左心耳封堵术（LAAO）治疗的伴有心房颤动（AF）和颅内出血（ICH）的患者的预后。
本研究共纳入来自北欧国家的 151 例 AF 合并既往 ICH 且接受 AMPLATZER 心脏塞或 AMPLATZER AMULET 行 LAAO 的患者，并与 151 例接受标准药物治疗的倾向评分匹配患者进行比较。两组的风险分层以便于两组的卒中风险和出血风险相似（CHA2DS2-VASc 和 HAS-BLED 评分）。标准治疗组患者从丹麦卒中登记处的 787 例 AF 合并 ICH 患者中确定。主要终点为全因死亡率、缺血性卒中和大出血的复合终点。与接受标准药物治疗的患者相比，接受 LAAO 治疗的伴有 AF 和既往 ICH 的患者复合终点的风险较低（事件/1000 年 [95%置信区间]：53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]；风险比 0.16 [0.07-0.37]）。
LAAO 可能对发生持续性 ICH 的 AF 患者具有重要的临床获益。这些结果需要在随机临床试验中得到证实。
