Sanjoy Shubrandu, Choi Yun-Hee, Holmes David, Herrman Howard, Terre Juan, Alraies Chadi, Ando Tomo, Tzemos Nikolaos, Mamas Mamas, Bagur Rodrigo
Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Heart. 2021 Jul 12;107(15):1246-1253. doi: 10.1136/heartjnl-2020-317741.
To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden.
Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHADS-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models.
A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHADS-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHADS-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE.
In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC.
评估左心耳封堵术（LAAC）后院内并发症的风险及其与合并症负担的关系。
基于队列的观察性研究，使用美国国家住院样本数据库，时间为2015年10月1日至2017年12月31日。主要关注的结局是院内主要不良事件（MAE）的发生，MAE定义为出血并发症、急性肾损伤、血管并发症、心脏并发症和术后卒中的综合。合并症负担和血栓栓塞风险通过Charlson合并症指数（CCI）、Elixhauser合并症评分（ECS）和CHADS-VASc评分进行评估。MAE通过国际疾病分类第十版临床修订版编码进行识别。使用逻辑回归模型评估合并症与院内MAE的关联。
共识别出3294例住院病例，其中，平均年龄为75.7±8.2岁，60%为男性，86%为白人。平均CHADS-VASc评分为4.3±1.5，29.5%的患者曾有过卒中或短暂性脑缺血发作。平均CCI和ECS分别为2.2±1.9和9.7±5.8。LAAC后院内MAE的总体综合发生率为4.6%。女性和非白人发生院内不良事件的几率约高出1.5倍，CCI较高（调整后比值比（aOR）：1.19，95%置信区间：1.13至1.24，p<0.001）、ECS较高（aOR：1.06，95%置信区间：1.05至1.08，p<0.001）和CHADS-VASc评分较高（aOR：1.08，95%置信区间：1.02至1.15，p=0.01）的参与者与院内MAE显著相关。
在这个大型LAAC患者队列中，大多数患者有显著的合并症负担。4.6%的患者发生了院内MAE，女性患者、非白人以及合并症负担较高的患者在LAAC后发生院内MAE的风险更高。
