Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, Calif; Department of Surgery, George Washington University, Washington, DC.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif.
J Thorac Cardiovasc Surg. 2018 Aug;156(2):578-585. doi: 10.1016/j.jtcvs.2018.02.089. Epub 2018 Mar 12.
The study objective was to evaluate the association between surgical left atrial appendage ligation and in-hospital stroke incidence after coronary artery bypass grafting among patients with atrial fibrillation.
A retrospective cohort study was performed by using the Nationwide Inpatient Sample between 2008 and 2014. All atrial fibrillation patients who underwent coronary artery bypass graft were included and categorized as left atrial appendage ligation or control group. Propensity score-weighted regression analyses were performed to assess the impact of left atrial appendage ligation on stroke incidence.
A total of 234,642 patients were identified, among whom 20,664 (8.81%) received concomitant left atrial appendage ligation. The national postoperative stroke incidence was 0.92%. Results of the propensity-weighted regression analysis showed no significant association between LAA ligation and control with regard to postoperative stroke (odds ratio [OR], 0.83; confidence interval [CI], 0.57-1.22; P = .35), pericardial complications (OR, 1.15; CI, 0.88-1.49; P = .31), hemorrhage and/or hematoma (OR, 1.08; CI, 0.99-1.17; P = .07), mortality (OR, 1.29; CI, 0.99-1.68; P = .06), and length of stay (coefficient -0.21; CI, -0.44-0.02; P = .08). There was no specific CHA2DS2VASC score cutoff above which left atrial appendage ligation was demonstrated to have lower postoperative stroke incidence.
The postoperative stroke risk after coronary artery bypass grafting was low at approximately 1% among patients with atrial fibrillation in the United States. Concomitant left atrial appendage ligation was not associated with lower postoperative stroke risk.
本研究旨在评估在接受冠状动脉旁路移植术（CABG）的房颤患者中，与手术左心耳结扎相关的住院期间卒中发生率。
本研究采用回顾性队列研究方法，使用 2008 年至 2014 年期间的全国住院患者样本。所有接受 CABG 的房颤患者均被纳入研究，并分为左心耳结扎组或对照组。采用倾向评分加权回归分析评估左心耳结扎对卒中发生率的影响。
共纳入 234642 例患者，其中 20664 例（8.81%）接受了同期左心耳结扎。全国术后卒中发生率为 0.92%。倾向评分加权回归分析结果显示，左心耳结扎组与对照组术后卒中（比值比 [OR]，0.83；置信区间 [CI]，0.57-1.22；P=0.35）、心包并发症（OR，1.15；CI，0.88-1.49；P=0.31）、出血和/或血肿（OR，1.08；CI，0.99-1.17；P=0.07）、死亡率（OR，1.29；CI，0.99-1.68；P=0.06）和住院时间（系数-0.21；CI，-0.44-0.02；P=0.08）无显著相关性。没有特定的 CHA2DS2VASC 评分切点表明左心耳结扎术后卒中发生率较低。
在美国房颤患者中，CABG 术后卒中风险约为 1%，较低。同期左心耳结扎与较低的术后卒中风险无关。
