Texas Cardiac Arrhythmia Institute, St.David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA.
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium.
Europace. 2023 Nov 2;25(11). doi: 10.1093/europace/euad315.
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO).
A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively.
Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
心房颤动（AF）和慢性肾脏病（CKD）常并存，并具有增加血栓栓塞（TE）的风险。CKD 同时易导致出血倾向。我们的目的是评估 CKD 在接受经皮左心耳封堵（LAAO）的患者中的预后价值。
根据基线时估算的肾小球滤过率，将 2124 例连续接受 LAAO 的 AF 患者分为 CKD 1+2 期（n = 1089）、CKD 3 期（n = 796）、CKD 4 期（n = 170）和 CKD 5 期（n = 69）。主要终点包括心血管（CV）死亡率、TE 和主要出血。根据 CHA2DS2-VASc 和 HAS-BLED 评分估计预期的年度 TE 和主要出血风险。随着 CKD 的恶化，观察到主要围手术期不良事件的发生率略有升高（1.7% vs. 2.3% vs. 4.1% vs. 4.3%）（P = 0.14）。平均随访时间为 13 ± 7 个月（2226 患者年）。与 CKD 1+2 作为参考相比，CKD 3 期（log-rank P 值= 0.04）、CKD 4 期（log-rank P 值= 0.01）和 CKD 5 期（log-rank P 值= 0.001）的主要终点发生率显著更高。左心耳封堵可使每组的 TE 风险降低 72%、66%、62%和 41%。主要出血的相对 RR 分别为 58%、44%、51%和 52%。
中重度 CKD 患者主要复合终点发生率较高。TE 和主要出血发生率的相对 RR 在 CKD 组中一致。
