Feroze Rafey, Saeed Yusef, Ullah Waqas, Alhabdan Nawaf, Cove Alexander, Frazzetto Marco, Tashtish Nour, Dallan Luis Augusto Palma, Filby Steven J
Harrington Heart & Vascular Institute, University Hospitals, Cleveland, Ohio.
Department of Medicine, University Hospitals, Cleveland, Ohio.
Am J Cardiol. 2025 May 1;242:61-67. doi: 10.1016/j.amjcard.2025.01.033. Epub 2025 Jan 31.
Percutaneous left atrial appendage occlusion (LAAO) is used to prevent stroke in atrial fibrillation. We present a national registry analysis of peri‑procedural outcomes of LAAO among patients with lower versus higher CHADS-VASc score. The National Readmissions Database was used to perform a retrospective review of all hospitalizations for percutaneous endocardial LAAO identified between September 2015 and November 2019. ICD codes for congestive heart failure, hypertension, type 2 diabetes, stroke, transient ischemic attack, thromboembolism, and vascular disease were identified. CHADS-VASc was calculated. Lower CHADS-VASc score was defined as <5 and higher score as ≥5. Propensity matched (PSM) analysis at index hospitalization and 30 days was used to compare a matched sample of patients undergoing LAAO with lower and higher CHADS-VASc. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion, and cardiac tamponade. A sample of patients who underwent LAAO with lower CHADS-VASc (n = 40,879) and higher CHADS-VASc (n = 14,438) was identified for crude analysis. From this cohort, a sample of patients with lower CHADS-VASc (n = 14,219) and higher CHADS-VASc (n = 14,388) was selected for PSM analysis. Both crude and PSM analyses at index hospitalization found higher odds of mortality in the higher CHADS-VASc group but no significant difference in odds of major bleeding, stroke, pericardial effusion, or cardiac tamponade. Our findings showed associated a higher CHADS-VASc score with a higher risk of mortality without an increased risk of common complications peri‑procedurally. In conclusion, findings display the overall safety of LAAO for patients with both lower and higher CHADS-VASc score.
经皮左心耳封堵术（LAAO）用于预防心房颤动患者发生中风。我们对CHADS-VASc评分较低和较高的患者进行了LAAO围手术期结局的全国性登记分析。利用国家再入院数据库对2015年9月至2019年11月期间确定的所有经皮心内膜LAAO住院病例进行回顾性研究。确定了充血性心力衰竭、高血压、2型糖尿病、中风、短暂性脑缺血发作、血栓栓塞和血管疾病的ICD编码。计算CHADS-VASc评分。较低的CHADS-VASc评分定义为<5，较高的评分定义为≥5。采用倾向匹配（PSM）分析对指数住院时和30天时CHADS-VASc评分较低和较高的LAAO患者匹配样本进行比较。检查的结局包括全因死亡率、中风、大出血、心包积液和心脏压塞。确定了CHADS-VASc评分较低（n = 40,879）和较高（n = 14,438）的LAAO患者样本进行粗分析。从该队列中，选择CHADS-VASc评分较低（n = 14,219）和较高（n = 14,388）的患者样本进行PSM分析。指数住院时的粗分析和PSM分析均发现，CHADS-VASc评分较高的组死亡率较高，但大出血、中风、心包积液或心脏压塞的发生率无显著差异。我们的研究结果表明，CHADS-VASc评分较高与较高的死亡风险相关，而围手术期常见并发症的风险并未增加。总之，研究结果显示LAAO对CHADS-VASc评分较低和较高的患者总体安全。
