Azizy Obayda, Rammos Christos, Lehmann Nils, Rassaf Tienush, Kälsch Hagen
1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany.
2 Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
Diab Vasc Dis Res. 2017 Sep;14(5):407-414. doi: 10.1177/1479164117712176. Epub 2017 Jun 8.
Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus.
We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study.
Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHADS-VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHADS-VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p < 0.001 for both). Pre- and periprocedural risk was elevated in patients with diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p < 0.01; Society of Thoracic Surgeons (STS)-Score: 4.0 ± 2.5 vs 2.6 ± 1.2, p < 0.01). Procedural success was similar. Periprocedural major adverse cardiac and cerebrovascular events occurred in one patient from the control group (2.1%), whereas patients with diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672).
Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.
左心耳封堵术是预防心房颤动相关血栓栓塞的一种治疗方法。糖尿病患者在经皮心脏介入治疗中出现不良结局的风险增加。我们评估了经皮左心耳封堵术在糖尿病患者中是否安全有效。
在一项开放标签的单中心观察性研究中，我们纳入了78例有左心耳封堵指征的患者（平均年龄74.4±8.3岁）。
与非糖尿病患者（n = 47，CHADS-VASc评分：3.5±1.0，HAS-BLED评分：4.1±0.8）相比，糖尿病患者（n = 31）的血栓栓塞和出血风险更高（CHADS-VASc评分：4.5±0.9，HAS-BLED评分：4.7±0.7；两者p均<0.001）。糖尿病患者术前和围手术期风险升高（欧洲心脏手术风险评估系统（Euro II）评分：6.6±3.7 vs 3.9±1.9，p<0.01；美国胸外科医师协会（STS）评分：4.0±2.5 vs 2.6±1.2，p<0.01）。手术成功率相似。对照组有1例患者发生围手术期严重心脑血管事件（2.1%），而糖尿病患者无此类事件发生（p = 0.672）。6个月的随访显示两组均无出血并发症。随访期间无卒中发生，左心耳血流速度降低情况（55.6±38.6 vs 51.4±19.1 cm/s，p = 0.474）以及左心耳介入后渗漏率相当（0% vs 2.1%，p = 0.672）。
尽管糖尿病患者属于高危患者，但经皮左心耳封堵术的结局与非糖尿病患者相似。
