Abibe Goia Adnan, Xu Meng, Qiuming Hu
Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University Affiliated Hospital, Beijing, China.
Front Cardiovasc Med. 2025 Jun 4;12:1601303. doi: 10.3389/fcvm.2025.1601303. eCollection 2025.
This study aimed to compare the efficacy of left atrial appendage closure performed by excision (LAAC-EE) vs. occlusion (LAAC-PO) for stroke prevention in patients with recurrent atrial fibrillation undergoing radiofrequency ablation.
In this retrospective analysis, 160 consecutive patients (109 undergoing LAAC-EE and 51 undergoing LAAC-PO) were evaluated. To adjust for baseline differences, stabilized inverse probability of treatment weighting (IPTW) was applied using a logistic regression model with age, sex, and CHA₂DS₂-VASc score as predictors. Weighted Kaplan-Meier survival analyses were conducted to assess stroke-free survival over a 5-year follow-up period, and weighted Cox proportional hazards regression was used to evaluate the association between LAAC modality and stroke occurrence, adjusting for age, sex, diabetes, CHA₂DS₂-VASc score, HAS-BLED score, and left atrium size.
Overall, the weighted mean CHA2DS2-VASc score was 3.1 ± 0.1 (3.0 ± 0.2 in LAAC-EE vs. 3.3 ± 0.2 in LAAC-PO; = 0.159), indicating moderate baseline stroke risk. When stratified, 39.2% of LAAC-EE and 18.9% of LAAC-PO patients were in the low-risk category (CHA2DS2-VASc ≤2), 48.2% vs. 69.6% in the medium-risk group (score 3-4), and 12.6% vs. 11.5% in the high-risk group (score ≥5) ( = 0.093). Over 5 years, stroke occurred in 64 patients-29.4% in the LAAC-EE group vs. 62.7% in LAAC-PO-and weighted Kaplan-Meier analysis showed significantly greater stroke-free survival with excision (log-rank < 0.001). In the weighted multivariate Cox model, LAAC-EE was associated with a non-significant 51.6% reduction in stroke risk (HR 0.48; 95% CI 0.13-1.74; = 0.27). Age (HR 1.09 per year; = 0.008) and HAS-BLED score (HR 10.54; < 0.001) remained significant predictors, whereas sex, diabetes, and CHA₂DS₂-VASc score did not.
Although the multivariate analysis did not achieve statistical significance for the treatment modality, the observed hazard ratio indicates that LAAC-EE may reduce stroke risk by approximately 51.6% compared to LAAC-PO. The significant impact of age and HAS-BLED score on stroke risk underscores the importance of individualized patient selection. These findings suggest a potential clinical benefit of LAAC-EE, particularly among lower-risk patients, and warrant further investigation in larger prospective studies.
本研究旨在比较切除法（LAAC-EE）与封堵法（LAAC-PO）进行左心耳封堵术对接受射频消融的复发性心房颤动患者预防卒中的疗效。
在这项回顾性分析中，对160例连续患者（109例行LAAC-EE，51例行LAAC-PO）进行了评估。为了调整基线差异，使用以年龄、性别和CHA₂DS₂-VASc评分作为预测因素的逻辑回归模型应用稳定的治疗权重逆概率（IPTW）。进行加权Kaplan-Meier生存分析以评估5年随访期内的无卒中生存情况，并使用加权Cox比例风险回归来评估LAAC方式与卒中发生之间的关联，同时调整年龄、性别、糖尿病、CHA₂DS₂-VASc评分、HAS-BLED评分和左心房大小。
总体而言，加权平均CHA2DS2-VASc评分为3.1±0.1（LAAC-EE组为3.0±0.2，LAAC-PO组为3.3±0.2；P = 0.159），表明基线卒中风险为中度。分层时，LAAC-EE组39.2%和LAAC-PO组18.9%的患者属于低风险类别（CHA2DS2-VASc≤2），中风险组分别为48.2%和69.6%（评分3 - 4），高风险组分别为12.6%和11.5%（评分≥5）（P = 0.093）。在5年期间，64例患者发生卒中——LAAC-EE组为29.4%，LAAC-PO组为62.7%——加权Kaplan-Meier分析显示切除法的无卒中生存率显著更高（对数秩检验P < 0.001）。在加权多变量Cox模型中，LAAC-EE与卒中风险降低51.6%相关，但无统计学意义（风险比0.48；95%置信区间0.13 - 1.74；P = 0.27）。年龄（每年风险比1.09；P = 0.008）和HAS-BLED评分（风险比10.54；P < 0.001）仍然是显著的预测因素，而性别、糖尿病和CHA₂DS₂-VASc评分则不是。
尽管多变量分析未达到治疗方式的统计学显著性，但观察到的风险比表明，与LAAC-PO相比，LAAC-EE可能使卒中风险降低约51.6%。年龄和HAS-BLED评分对卒中风险的显著影响强调了个体化患者选择的重要性。这些发现表明LAAC-EE具有潜在的临床益处，特别是在低风险患者中，值得在更大规模的前瞻性研究中进一步调查。
