Long-term Event Reduction After Left Atrial Appendage Closure. Results of the Iberian Registry II

被引：26

作者：

Lopez-Minguez, Jose R. ^{[1
]}

Nogales-Asensio, Juan M. ^{[1
]}

De Oliveira, Eduardo Infante ^{[2
]}

Ribeiro, Vasco De Gama ^{[3
]}

Ruiz-Salmeron, Rafael ^{[4
]}

Arzamendi-Aizpurua, Dabit ^{[5
]}

Costa, Marco ^{[6
]}

Gutierrez-Garcia, Hipolito ^{[7
]}

Antonio Fernandez-Diaz, Jose ^{[8
]}

Martin-Yuste, Victoria ^{[9
]}

Carlos Rama-Merchan, Juan ^{[10
]}

Moreno-Gomez, Raul ^{[11
]}

Benedicto-Buendia, Amparo ^{[12
]}

Iniguez-Romo, Andres ^{[13
]}

机构：

[1] Hosp Infanta Cristina, Serv Cardiol, Avda Elvas S-N, Badajoz 06080, Spain

[2] Hosp Santa Maria, Serv Cardiol, Lisbon, Portugal

[3] Ctr Hosp Vila Nova Gaia, Serv Cardiol, Oporto, Portugal

[4] Hosp Virgen Macarena, Serv Cardiol, Seville, Spain

[5] Hosp Santa Creu & Sant Pau, Serv Cardiol, Barcelona, Spain

[6] Ctr Hosp & Univ Coimbra, Serv Cardiol, Coimbra, Portugal

[7] Hosp Clin Valladolid, Serv Cardiol, Valladolid, Spain

[8] Hosp Puerta Hierro, Serv Cardiol, Madrid, Spain

[9] Hosp Clin Barcelona, Serv Cardiol, Barcelona, Spain

[10] Hosp Univ Salamanca, Serv Cardiol, Salamanca, Spain

[11] Hosp La Paz, Serv Cardiol, Madrid, Spain

[12] Hosp La Princesa, Serv Cardiol, Madrid, Spain

[13] Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Pontevedra, Spain

来源：

REVISTA ESPANOLA DE CARDIOLOGIA | 2019年 / 72卷 / 06期

关键词：

Left atrial appendage closure; Bleeding; Stroke; Nonvalvular atrial fibrillation; Mortality; AMPLATZER CARDIAC PLUG; STROKE PREVENTION; WATCHMAN DEVICE; ISCHEMIC-STROKE; FIBRILLATION; WARFARIN; OCCLUSION; RISK; ANTICOAGULATION; THROMBUS;

D O I：

10.1016/j.rec.2018.03.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction and objectives: Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality. Methods: Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA(2)DS(2)-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up. Results: A total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA(2)DS(2)-VASc; P < .001); intracranial hemorrhage 0.8%; gastrointestinal bleeding 3.2%; severe bleeding 3.9% (vs 6.3% expected by HAS-BLED, P = .002). These results were improved in the subgroup of 176 patients with follow-up > 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P < .033). The factors significantly associated with higher mortality were age (HR, 1.1), intracranial hemorrhage (HR, 6.8), and stroke during follow-up (HR, 2.7). Conclusions: Left atrial appendage closure significantly reduced the incidence of stroke and bleeding events and the benefit was maintained. Intracranial hemorrhage, age and stroke were associated with higher mortality. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

引用

页码：449 / 455

页数：7

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