Maarse Moniek, Aarnink Errol W, Huijboom Marina F M, Abeln Bob G S, Staal Diederik, Rensing Benno J W M, Kerklaan Joost P, van Dijk Vincent F, Swaans Martin J, Boersma Lucas V A
Cardiology Department, St. Antonius Hospital, Nieuwegein, the Netherlands.
Cardiology Department, Amsterdam UMC, Amsterdam, the Netherlands.
Heart Rhythm O2. 2023 Mar 17;4(5):298-308. doi: 10.1016/j.hroo.2023.03.002. eCollection 2023 May.
Percutaneous left atrial appendage occlusion (LAAO) is an alternative to anticoagulation in the prevention of stroke in patients with nonvalvular atrial fibrillation, especially in patients with a contraindication for oral anticoagulation therapy (OAT).
The study sought to obtain long-term patient outcomes after successful LAAO in everyday clinical practice.
In this single-center registry spanning over 10 years, data of all consecutive patients that underwent percutaneous LAAO were collected. Observed thromboembolic and major bleeding event rates after successful LAAO during follow-up were compared with expected event rates based on CHADS-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) and HAS-BLED (hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores. Furthermore, anticoagulation and antiplatelet use during follow-up was evaluated.
Of 230 patients scheduled for LAAO (38% women, 69.5 ± 8.2 years of age, CHADS-VASc score 3.9 ± 1.6, HAS-BLED score 2.9 ± 1.0), 218 patients had a successful implantation (95%) with a follow-up duration of 5.2 ± 3.1 years. The procedure was combined with catheter ablation in 52% of the patients. Fifty thromboembolic complications (24 ischemic stroke, 26 transient ischemic attack) were observed during follow-up in 40 (18%) of 218 patients. Ischemic strokes occurred with a rate of 2.1 per 100 patient-years, accounting for a 66% relative risk reduction compared with the CHADS-VASc predicted event rate. Device-related thrombus was observed in 5 (2%) patients. Sixty-five nonprocedural major bleeding complications occurred in 24 (11%) of 218 patients with a rate of 5.7 per 100-patient years, which is comparable to estimated HAS-BLED-bleeding rates under OAT use. At end of follow-up 71% of all patients were on single antiplatelet or no antiplatelet or anticoagulation treatment, while 29% were on OAT.
Thromboembolic event rates during long-term follow-up after successful LAAO remained consistently lower than expected supporting the efficacy of LAAO.
经皮左心耳封堵术（LAAO）是预防非瓣膜性心房颤动患者中风的一种抗凝替代方法，尤其适用于口服抗凝治疗（OAT）有禁忌证的患者。
本研究旨在获取日常临床实践中成功进行LAAO后的长期患者预后情况。
在这个跨度超过10年的单中心登记研究中，收集了所有连续接受经皮LAAO患者的数据。将随访期间成功进行LAAO后观察到的血栓栓塞和大出血事件发生率与基于CHADS-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往中风或短暂性脑缺血发作或血栓栓塞、血管疾病、年龄65 - 74岁、性别分类）和HAS-BLED（高血压、肾功能或肝功能异常、中风、出血、国际标准化比值不稳定、老年、药物或酒精）评分的预期事件发生率进行比较。此外，还评估了随访期间的抗凝和抗血小板药物使用情况。
在计划进行LAAO的230例患者中（女性占38%，年龄69.5±8.2岁，CHADS-VASc评分为3.9±1.6，HAS-BLED评分为2.9±1.0），218例患者成功植入（95%），随访时间为5.2±3.1年。52%的患者该手术与导管消融联合进行。在218例患者中的40例（18%）随访期间观察到50例血栓栓塞并发症（24例缺血性中风，26例短暂性脑缺血发作）。缺血性中风发生率为每100患者年2.1例，与CHADS-VASc预测事件发生率相比相对风险降低了66%。5例（2%）患者观察到与器械相关的血栓。218例患者中的24例（11%）发生了65例非手术相关的大出血并发症，发生率为每100患者年5.7例，这与OAT使用情况下估计的HAS-BLED出血率相当。随访结束时，71%的患者接受单一抗血小板治疗或未接受抗血小板或抗凝治疗，而29%的患者接受OAT治疗。
成功进行LAAO后的长期随访期间，血栓栓塞事件发生率持续低于预期，支持LAAO的有效性。
