Pieper Justin, Bhuta Sapan, Poliner Michael, Hansen Brian J, Ward Chad C, Savona Salvatore J, Augostini Ralph S, Kalbfleisch Steven J, Afzal Muhammad R, Houmsse Mahmoud, Daoud Emile G, Hummel John D
Electrophysiology Section, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Cardiovasc Electrophysiol. 2025 Aug;36(8):1703-1709. doi: 10.1111/jce.16502. Epub 2024 Dec 9.
There is a paucity of data regarding the optimal timing of left atrial appendage closure (LAAC) and whether scheduling delays increase the risk for adverse outcomes.
This study sought to assess the incidence and predictors of adverse events among patients awaiting LAAC.
This single-center retrospective study assessed all patients who underwent LAAC from January 2017 to March 2020. The primary study endpoints were the rate and characteristics of adverse events occurring from the time of initial shared decision to pursue LAAC until the time of LAAC. Adverse events were defined as clinically significant bleeding or anemia, thromboembolic complications, or death. Patients were censored after successful closure or the first adverse event.
Two hundred and sixty-five patients underwent LAAC with demographics notable for age 73.5 ± 8.1 years, 98 (37%) females, left ventricular ejection fraction 52.3% ± 10.4%, CHADS-VASc 4.8 ± 1.4, and HAS-BLED 3.2 ± 1.2. Median time from shared decision to insurance approval and insurance approval to LAAC were 18 (IQR 28) and 44 (IQR 40) days, respectively. Seventeen (6%) patients suffered an adverse event, including 15 (88%) cases of bleeding or anemia and 2 (12%) cases of thromboembolism. Multivariate analysis demonstrated that increased time to LAAC (odds ratio [OR] 1.31, 95% confidence interval [CI] [1.15, 1.50], p < 0.001) and higher HAS-BLED score (OR 1.67, CI [1.11, 2.59], p = 0.017) were associated with significantly increased risk for adverse events.
Prolonged time to LAAC and higher HAS-BLED score portend an increased risk for adverse events while awaiting LAAC. Expedited closure is warranted in high-risk patients.
关于左心耳封堵术（LAAC）的最佳时机以及延迟手术安排是否会增加不良结局风险的数据较少。
本研究旨在评估等待LAAC患者不良事件的发生率及预测因素。
这项单中心回顾性研究评估了2017年1月至2020年3月期间所有接受LAAC的患者。主要研究终点是从最初共同决定进行LAAC到LAAC实施期间发生不良事件的发生率和特征。不良事件定义为具有临床意义的出血或贫血、血栓栓塞并发症或死亡。成功封堵或首次发生不良事件后对患者进行截尾。
265例患者接受了LAAC，其人口统计学特征为年龄73.5±8.1岁，女性98例（37%），左心室射血分数52.3%±10.4%，CHADS-VASc评分为4.8±1.4，HAS-BLED评分为3.2±1.2。从共同决定到保险批准以及从保险批准到LAAC的中位时间分别为18天（四分位间距28天）和44天（四分位间距40天）。17例（6%）患者发生了不良事件，包括15例（88%）出血或贫血病例和2例（12%）血栓栓塞病例。多因素分析表明，LAAC时间延长（比值比[OR]1.31，95%置信区间[CI][1.15，1.50]，p<0.001）和较高的HAS-BLED评分（OR 1.67，CI[1.11，2.59]，p=0.017）与不良事件风险显著增加相关。
LAAC时间延长和较高的HAS-BLED评分预示着等待LAAC期间不良事件风险增加。高危患者有必要加快封堵。
