Singh Sheldon M, Qui Feng, Wijeysundera Harindra C
Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2023 Jul 17;5(10):770-778. doi: 10.1016/j.cjco.2023.07.006. eCollection 2023 Oct.
Percutaneous left atrial appendage occlusion (LAAO) is an alternative for stroke prevention in patients with atrial fibrillation with contraindications to oral anticoagulation. Population-level real-world data describing the use and outcomes of LAAO procedures are evolving, with a paucity of longer-term follow-up data. We report on the patient characteristics, procedure complications, and longer-term clinical outcomes in all patients undergoing LAAO procedures in Ontario, Canada.
All patients undergoing LAAO procedure between April 1, 2013 and March 31, 2022 were identified. Linked administrative databases were utilized to determine patient clinical and procedural characteristics. Outcomes of interest included procedural complications at 7 and 30 days, and longer-term rates of stroke, bleeding, all-cause rehospitalization, and mortality.
A total of 549 individuals were included in the study cohort. The average age was 75 ± 8 years, with 66% being of male sex, with a mean CHADSVASc score of 4.4 ± 1.6, and with 68% not receiving oral anticoagulation. Follow-up for 2.6 ± 2.0 patient-years was available. Stroke occurred in 2.8% during the follow-up period (1.1 per 100 patient-years), bleeding in 10% (4.0 per 100 patient-years), and any hospital readmission in 63% (43 per 100 patient-years). A total of 29% of the cohort died during the follow-up period (11 per 100 patient-years), with 1.8% of the cohort dying during the procedural hospitalization. The mortality rate was unchanged during the study period ( for trend = 0.72).
Long-term stroke and bleeding rates are low in patients undergoing LAAO procedures in Ontario, Canada. All-cause mortality in this population is high and remained unchanged during the study period.
经皮左心耳封堵术（LAAO）是房颤患者口服抗凝治疗存在禁忌时预防卒中的一种替代方法。描述LAAO手术应用情况和结局的人群水平真实世界数据不断发展，但长期随访数据较少。我们报告了加拿大安大略省所有接受LAAO手术患者的特征、手术并发症及长期临床结局。
确定2013年4月1日至2022年3月31日期间所有接受LAAO手术的患者。利用关联的行政数据库确定患者的临床和手术特征。感兴趣的结局包括术后7天和30天的手术并发症，以及卒中、出血、全因再住院和死亡率的长期发生率。
研究队列共纳入549例患者。平均年龄为75±8岁，66%为男性，平均CHADSVASc评分为4.4±1.6，68%未接受口服抗凝治疗。可获得2.6±2.0患者年的随访数据。随访期间卒中发生率为2.8%（每100患者年1.1例），出血发生率为10%（每100患者年4.0例），任何原因的再住院率为63%（每100患者年43例）。随访期间队列中共有29%的患者死亡（每100患者年11例），1.8%的患者在手术住院期间死亡。研究期间死亡率无变化（趋势检验P=0.72）。
在加拿大安大略省，接受LAAO手术的患者长期卒中及出血发生率较低。该人群全因死亡率较高，且在研究期间保持不变。
