Percutaneous left atrial appendage closure for stroke prevention in hypertrophic cardiomyopathy patients with atrial fibrillation

被引:1
|
作者
Aglan, Amro [1 ]
Fath, Ayman R. [2 ]
Maron, Barry J. [1 ]
Maron, Martin S. [1 ]
Prasad, Anand [2 ]
Almomani, Ahmed [2 ]
Hammadah, Muhammad [2 ]
Reynolds, Matthew R. [1 ]
Rowin, Ethan J. [1 ]
机构
[1] Lahey Hosp & Med Ctr, Hypertroph Cardiomyopathy Ctr, 67 S Bedford St,Ste 302W, Burlington, MA 01803 USA
[2] Univ Texas Hlth Sci Ctr San Antonio, Div Cardiol, San Antonio, TX USA
关键词
Hypertrophic cardiomyopathy; Atrial fi brillation; Left atrial appendage occlusion device; Stroke; Bleeding; CLINICAL PROFILE; RISK; WARFARIN; ANTICOAGULATION; MANAGEMENT; HEMORRHAGE;
D O I
10.1016/j.hrthm.2024.05.038
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Percutaneous left atrial appendage closure (LAAC) is an effective alternative strategy for stroke prevention in patients with atrial fi brillation (AF) at high risk for bleeding with anticoagulation (AC). Efficacy fi cacy of this strategy in hypertrophic cardiomyopathy (HCM) remains uncertain. OBJECTIVE The study aimed to compare risk of stroke in HCM-AF patients treated with LAAC with those treated with AC. METHODS By use of the TriNetX Global Research Network, HCM-AF patients from 2015 to 2024 were assigned to categories of treatment with LAAC and treatment solely with AC and observed for 3 years for ischemic stroke, systemic embolism, and all- cause mortality. Propensity score matching was used to limit confounders. RESULTS Of 14,867 HCM-AF patients identified, fi ed, 364 (2.5%) were treated with LAAC vs 14,503 (97.5%) treated with AC. HCM LAAC patients were older (72 vs 67 years; P < .001) and had more comorbidities and more prior bleeding events, including higher rate of prior gastrointestinal bleeding (68% vs 18%; P < .001), compared with HCM patients treated solely with AC. After propensity score matching, there was no baseline difference between groups including prior bleeding events (P P > .05). During follow-up, HCM patients treated with LAAC had higher rates of ischemic stroke (13% vs 8%; hazard ratio, 1.9; P = . 006) and systemic embolism (14% vs 9%; hazard ratio, 1.8; P = . 006) but no difference in mortality compared with matched HCM patients receiving AC. CONCLUSION These real-world data do not support percutaneous LAAC in HCM-AF patients as the primary treatment strategy during long-term AC to reduce stroke risk. However, LAAC may remain a reasonable option for HCM-AF patients who are unable to tolerate AC because of prohibitive bleeding risk.
引用
收藏
页码:1677 / 1683
页数:7
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