Cruz-González Ignacio, Ince Hueseyin, Kische Stephan, Schmitz Thomas, Schmidt Boris, Gori Tommaso, Foley David, de Potter Tom, Tschishow Wladimir, Vireca Elisa, Stein Kenneth, Boersma Lucas V
Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain.
Kardiologie, Vivantes Klinikum Am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.
Rev Esp Cardiol (Engl Ed). 2020 Jan;73(1):21-27. doi: 10.1016/j.rec.2019.02.008. Epub 2019 Apr 5.
Elderly patients with atrial fibrillation are at greater risk of both cardioembolic events and major bleeding than younger patients. Left atrial appendage occlusion (LAAO) could be an attractive alternative for these patients, but there are limited data on outcomes with LAAO in patients ≥ 85 years old. The aim of the present study was to assess the safety and efficacy of LAAO in patients ≥ 85 years old.
A total of 1025 patients included in the EWOLUTION registry who underwent LAAO were analyzed and 84 patients ≥ 85 years old were identified and compared with the younger cohort.
Patients ≥ 85 years old had higher estimated stroke and hemorrhagic risks than younger patients (CHADS-VASc: 5.2±1.2 vs 4.4±1.6, P <.0001; HAS-BLED: 2.7±1.1 vs 2.3±1.2; P=.003; ≥ 85 years vs <85 years). Procedural success was high and similar in both groups (98.8% vs 98.5%; P=.99). There were no differences in 7-day device- or procedure-related adverse event rates (2.6% in ≥ 85 years vs 3.1% in <85 years; P=.80). Despite the higher baseline stroke risk, there was no difference at follow-up between the groups in the annualized stroke rate (0.8/100 patient-years in ≥ 85 years vs 1.3/100 patient-years in <85 years; P=.649).
LAAO in patients ≥ 85 years is safe and effective even though these patients are at high risk for embolic and hemorrhagic events. LAAO may be a reasonable alternative to oral anticoagulation in these patients.
与年轻患者相比，老年房颤患者发生心脏栓塞事件和大出血的风险更高。左心耳封堵术（LAAO）可能是这类患者的一个有吸引力的替代方案，但关于≥85岁患者LAAO治疗结果的数据有限。本研究的目的是评估≥85岁患者LAAO的安全性和有效性。
对EWOLUTION注册研究中1025例行LAAO的患者进行分析，确定84例≥85岁的患者，并与年轻队列进行比较。
≥85岁的患者估计的卒中风险和出血风险高于年轻患者（CHADS-VASc评分：5.2±1.2 vs 4.4±1.6，P<.0001；HAS-BLED评分：2.7±1.1 vs 2.3±1.2；P=.003；≥85岁 vs <85岁）。两组手术成功率均较高且相似（98.8% vs 98.5%；P=.99）。7天内与器械或手术相关的不良事件发生率无差异（≥85岁组为2.6%，<85岁组为3.1%；P=.80）。尽管基线卒中风险较高，但随访时两组的年化卒中率无差异（≥85岁组为0.8/100患者年，<85岁组为1.3/100患者年；P=.649）。
≥85岁患者的LAAO是安全有效的，尽管这些患者发生栓塞和出血事件的风险较高。LAAO可能是这些患者口服抗凝治疗的合理替代方案。
