Khan Muhammad Zia, Shatla Islam, Darden Douglas, Neely Joseph, Mir Tanveer, Abideen Asad Zain Ul, Agarwal Siddharth, Raina Sameer, Balla Sudarshan, Singh Gagan D, Srivatsa Uma, Munir Muhammad Bilal
Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
Department of Internal Medicine, Kansas University Medical Center, Kansas City, Kansas.
Heart Rhythm O2. 2023 Jun 8;4(7):433-439. doi: 10.1016/j.hroo.2023.06.002. eCollection 2023 Jul.
Percutaneous left atrial appendage occlusion (LAAO) has proved to be a safer alternative for long-term anticoagulation; however, patients with a history of intracranial bleeding were excluded from large randomized clinical trials.
The purpose of this study was to determine outcomes in atrial fibrillation (AF) patients with a history of intracranial bleeding undergoing percutaneous LAAO.
National Inpatient Sample and International Classification of Diseases, Tenth Revision, codes were used to identify patients with AF who underwent LAAO during the years 2016-2020. Patients were stratified based on a history of intracranial bleeding vs not. The outcomes assessed in our study included complications, in-hospital mortality, and resource utilization.
A total of 89,300 LAAO device implantations were studied. Approximately 565 implantations (0.6%) occurred in patients with a history of intracranial bleed. History of intracranial bleeding was associated with a higher prevalence of overall complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, intracranial bleeding was found to be independently associated with in-patient mortality (adjusted odds ratio [aOR] 4.27; 95% confidence interval [CI] 1.68-10.82); overall complications (aOR 1.74; 95% CI 1.36-2.24); prolonged length of stay (aOR 2.38; 95% CI 1.95-2.92); and increased cost of hospitalization (aOR 1.28; 95% CI 1.08-1.52) after percutaneous LAAO device implantation.
A history of intracranial bleeding was associated with adverse outcomes after percutaneous LAAO. These data, if proven in a large randomized study, can have important clinical consequences in terms of patient selection for LAAO devices.
经皮左心耳封堵术（LAAO）已被证明是长期抗凝治疗的一种更安全的替代方法；然而，有颅内出血病史的患者被排除在大型随机临床试验之外。
本研究的目的是确定有颅内出血病史的心房颤动（AF）患者接受经皮LAAO后的结局。
使用国家住院患者样本和国际疾病分类第十版编码来识别2016年至2020年期间接受LAAO的AF患者。根据有无颅内出血病史对患者进行分层。我们研究中评估的结局包括并发症、住院死亡率和资源利用情况。
共研究了89300例LAAO器械植入病例。约565例植入（0.6%）发生在有颅内出血病史的患者中。在粗分析中，颅内出血病史与总体并发症和住院死亡率的较高患病率相关。在对潜在混杂因素进行调整的多变量模型中，发现颅内出血与住院死亡率（调整后的优势比[aOR]4.27；95%置信区间[CI]1.68-10.82）、总体并发症（aOR 1.74；95%CI 1.36-2.24）、住院时间延长（aOR 2.38；95%CI 1.95-2.92）以及经皮LAAO器械植入后住院费用增加（aOR 1.28；95%CI 1.08-1.52）独立相关。
颅内出血病史与经皮LAAO后的不良结局相关。这些数据如果在大型随机研究中得到证实，在LAAO器械的患者选择方面可能会产生重要的临床影响。
