Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION trial

被引:5
作者
Aarnink, Errol W. [1 ]
Ince, Hueseyin [2 ,3 ]
Kische, Stephan [4 ]
Pokushalov, Evgeny [5 ]
Schmitz, Thomas
Schmidt, Boris [7 ]
Gori, Tommaso [6 ,8 ,9 ]
Meincke, Felix [10 ]
Protopopov, Alexey Vladimir [11 ]
Betts, Timothy [12 ]
Mazzone, Patrizio [13 ]
Grygier, Marek [14 ]
Sievert, Horst [15 ]
De Potter, Tom [16 ]
Vireca, Elisa [1 ,17 ]
Stein, Kenneth [18 ]
Bergmann, Martin W. [19 ]
Boersma, Lucas V. A. [1 ]
机构
[1] St Antonius Ziekenhuis Nieuwegein AUMC Amsterdam, Dept Cardiol, Koekoekslaan 1, NL-3435 CM Nieuwegein, Netherlands
[2] Vivantes Klinikum Urban & Neukolln, Dept Cardiol, Berlin, Germany
[3] Univ Med Rostock, Dept Cardiol, Rostock, Germany
[4] Vivantes Klinikum Friedrichshain, Dept Cardiol, Berlin, Germany
[5] State Res Inst Circulat Pathol, Novosibirsk, Russia
[6] Elisabeth Krankenhaus Essen, Dept Cardiol, Essen, Germany
[7] Cardioangiol Ctr Bethanien, Frankfurt, Germany
[8] Univ Med Mainz, Dept Cardiol, Mainz, Germany
[9] DZHK Standort Rhein Main, Mainz, Germany
[10] Asklepios Klin Altona, Dept Cardiol, Hamburg, Germany
[11] Reg Cardiol Hosp, Ctr Diagnost & Cardiovasc Surg, Surgut, Russia
[12] Oxford Univ Hosp NHS Trust, Dept Cardiol, Oxford, England
[13] San Raffaele Univ Hosp, Arrhythmol & Cardiac Pacing Unit, Milan, Italy
[14] Poznan Univ Med Sci, Chair & Dept Cardiol 1, Poznan, Poland
[15] Cardiovasc Ctr Frankfurt, Frankfurt, Germany
[16] Onze Lieve Vrouw Hosp, Dept Cardiol, Aalst, Belgium
[17] Boston Sci, Diegem, Belgium
[18] Boston Sci, St Paul, MN USA
[19] Asklepios Klin Altona, Dept Cardiol & Intens Care Med, Hamburg, Germany
来源
EUROPACE | 2024年 / 26卷 / 07期
关键词
Atrial fibrillation; Left atrial appendage occlusion; Mortality; Risk stratification; FIBRILLATION; CLOSURE; DEVICE; STROKE; CONTRAINDICATION; PREVENTION; WATCHMAN; OUTCOMES; RISK;
D O I
10.1093/europace/euae188
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Sufficient survival time following left atrial appendage occlusion (LAAO) is essential for ensuring the efficacy and cost-effectiveness of this strategy for stroke prevention. Understanding prognostic factors for early mortality after LAAO could optimize patient selection. In the current study, we perform an in-depth analysis of 2-year mortality after LAAO, focusing particularly on potential predictors.Methods and results The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were pre-specified, and death was categorized as cardiovascular, non-cardiovascular, or unknown origin. Mortality rates were calculated from Kaplan-Meier estimates. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model. Two-year mortality rate was 16.4% [confidence interval (CI): 14.0-18.7%], with 50% of patients dying from a non-cardiovascular cause. Multivariate baseline predictors of 2-year mortality included age [hazard ratio (HR) 1.05, CI: 1.03-1.08, per year increase], heart failure (HR 1.73, CI: 1.24-2.41), vascular disease (HR 1.47, CI: 1.05-2.05), valvular disease (HR 1.63, CI: 1.15-2.33), abnormal liver function (HR 1.80, CI: 1.02-3.17), and abnormal renal function (HR 1.58, CI: 1.10-2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors.Conclusion One in six patients died within 2 years after LAAO. We identified six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO.Clinical trial registration The original EWOLUTION registry was registered at clinicaltrials.gov under identifier NCT01972282. Graphical Abstract The mortality risk within EWOLUTION increased gradually with a growing number of risk factors. Risk factors included age, heart failure, vascular disease, valvular disease, abnormal liver function, and abnormal kidney function. CI, confidence interval; IR, incidence rate; RF, risk factor.
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页数:11
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