Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
CardioVasculäres Centrum, Frankfurt, Germany.
Clin Res Cardiol. 2022 Nov;111(11):1276-1285. doi: 10.1007/s00392-022-02065-4. Epub 2022 Jul 18.
Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.
We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.
Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).
DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.
左心耳封堵 (LAAC) 术后与器械相关的血栓 (DRT) 的相关数据仍然有限。本研究旨在通过向 EUROC-DRT 登记处报告的中心，调查 DRT 的风险因素。
我们纳入了 537 名患者（112 名有 DRT，425 名无 DRT），他们在 2008 年 12 月至 2019 年 4 月期间接受了 LAAC。在单变量和多变量分析中，比较了两组患者的基线和植入特征、抗血栓治疗和临床结局。另外还进行了倾向评分匹配 (PSM) 以重点研究植入特征的作用。
有 DRT 的患者先前中风/短暂性脑缺血发作 (TIA) 的发生率更高（49.1% vs. 34.7%，p<0.01），自发性超声心动图对比（SEC）发生率更高（44.9% vs. 27.7%，p<0.01），左心耳排空速度更低（35.4±18.5 vs. 42.4±18.0 cm/s，p=0.02）。在 DRT 患者中植入的封堵器更大（25.5±3.8 vs. 24.6±3.5 mm，p=0.03），植入深度更深（平均深度：7.6±4.7 vs. 5.7±4.7 mm，p<0.01）。DRT 患者的左心耳开口覆盖程度更低（69.5% vs. 81.5%，p<0.01），同时 DRT 患者接受口服抗凝治疗的比例更低（7.1% vs. 16.7%，p<0.01）。多变量分析确定年龄、既往中风/TIA 和 SEC 是 DRT 的独立危险因素。在 PSM 后，植入深度被发现是一个预测因素。DRT 患者中风/TIA 发生率更高（13.5% vs. 3.8%，风险比：4.21[95%-置信区间：1.88-9.49]，p<0.01）。
LAAC 术后 DRT 与不良结局相关，似乎是多因素引起的，取决于患者特征、抗凝方案和器械位置。
