Maraey Ahmed, Elsharnoby Hadeer, Mahmoud Mona, Chacko Paul, Moukarbel George V
Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, United States of America.
Department of Internal Medicine, University of Toledo, Toledo, OH, United States of America.
Cardiovasc Revasc Med. 2025 May;74:81-82. doi: 10.1016/j.carrev.2024.12.007. Epub 2024 Dec 22.
Percutaneous left atrial appendage occlusion (pLAAO) presents an alternative to anticoagulation (AC) for stroke prophylaxis in atrial fibrillation (Afib) patients with high bleeding risk. pLAAO was associated with lower rates of disabling stroke which was mainly attributed to the reduction of hemorrhagic stroke (HS). Little is known about the impact of pLAAO on the severity of ischemic strokes which we sought to study.
The study is a retrospective analysis of the National Readmission Database for the years 2016-2020. All 6-month readmissions with IS after pLAAO admissions were identified. The control group comprised patients with Afib on AC who were admitted for IS. Patients with intracranial hemorrhage or those who underwent surgical LAAO were excluded. A propensity score matching system was utilized to match both groups. Treatment effects were presented as percentages and odds ratio (OR) with 95 % confidence interval (CI).
A total of 342 observations in each group were matched (weighted estimate: 583 in the pLAAO group and 663 in the control group). pLAAO group was associated with a decreased risk of fatal stroke (5.1 % vs. 10.0 %, OR: 0.48, 95 % CI [0.26-0.88], P = 0.018), and a decreased risk of non-fatal severe stroke (50.5 % vs. 59.6 %, OR: 0.69, 95 % CI [0.50-0.96], P = 0.029) at 6 months follow-up.
Compared with patients on AC, patients with pLAAO admitted with ischemic strokes are less likely to have severe and fatal stroke. Further studies are needed to validate our findings.
经皮左心耳封堵术（pLAAO）为出血风险高的心房颤动（房颤）患者预防中风提供了一种抗凝（AC）替代方案。pLAAO与致残性中风发生率较低相关，这主要归因于出血性中风（HS）的减少。我们试图研究pLAAO对缺血性中风严重程度的影响，但对此知之甚少。
本研究是对2016 - 2020年国家再入院数据库的回顾性分析。确定了所有在pLAAO入院后6个月因缺血性中风（IS）再次入院的患者。对照组包括因IS入院的接受AC治疗的房颤患者。排除颅内出血患者或接受外科左心耳封堵术的患者。采用倾向评分匹配系统对两组进行匹配。治疗效果以百分比和比值比（OR）及95%置信区间（CI）表示。
每组共匹配了342例观察对象（加权估计：pLAAO组583例，对照组663例）。在6个月随访时，pLAAO组致命性中风风险降低（5.1%对10.0%，OR：0.48，95%CI[0.26 - 0.88]，P = 0.018），非致命性严重中风风险降低（50.5%对59.6%，OR：0.69，95%CI[0.50 - 0.96]，P = 0.029）。
与接受AC治疗的患者相比，因缺血性中风入院的pLAAO患者发生严重和致命性中风的可能性较小。需要进一步研究来验证我们的发现。
