Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

被引：82

作者：

Kefer, Joelle ^{[1
]}

Tzikas, Apostolos ^{[2
]}

Freixa, Xavier ^{[3
]}

Shakir, Samera ^{[4
]}

Gafoor, Sameer ^{[5
,23
]}

Nielsen-Kudsk, Jens Erik ^{[6
]}

Berti, Sergio ^{[7
]}

Santoro, Gennaro ^{[8
]}

Aminian, Adel ^{[9
]}

Landmesser, Ulf ^{[10
]}

Nietlispach, Fabian ^{[4
,10
]}

Ibrahim, Reda ^{[11
]}

Danna, Paolo Luciano ^{[12
]}

Benit, Edouard ^{[13
]}

Budts, Werner ^{[14
]}

Stammen, Francis ^{[15
]}

De Potter, Tom ^{[16
]}

Tichelbaecker, Tobias ^{[17
]}

Gloekler, Steffen ^{[4
]}

Kanagaratnam, Prapa ^{[18
]}

Costa, Marco ^{[19
]}

Cruz-Gonzalez, Ignacio ^{[20
]}

Sievert, Horst ^{[5
]}

Schillinger, Wolfgang ^{[17
]}

Park, Jai-Wun ^{[21
]}

Meier, Bernhard ^{[4
]}

Omran, Heyder ^{[22
]}

机构：

[1] Clin Univ St Luc, B-1200 Brussels, Belgium

[2] Interbalkan European Med Ctr, Thessaloniki, Greece

[3] Univ Barcelona, Hosp Clin, Barcelona, Spain

[4] Univ Hosp Bern, CH-3010 Bern, Switzerland

[5] CardioVasc Ctr Frankfurt, Frankfurt, Germany

[6] Aarhus Univ Hosp, Skejby, Denmark

[7] Fdn CNR Reg Toscana, Heart Hosp, Massa, Italy

[8] Osped Careggi Firenze, Florence, Italy

[9] Ctr Hosp Univ Charleroi, Charleroi, Belgium

[10] Univ Zurich Hosp, CH-8091 Zurich, Switzerland

[11] Montreal Heart Inst, Montreal, PQ H1T 1C8, Canada

[12] Osped L Sacco, Milan, Italy

[13] Jessaziekenhuis, Hasselt, Belgium

[14] UZ Leuven, Leuven, Belgium

[15] AZ Delta Roeselare, Roeselare, Belgium

[16] Onze Lieve Vrouw Hosp, Aalst, Belgium

[17] Univ Med Gottingen, Gottingen, Germany

[18] Imperial Coll Healthcare NHS Trust, London, England

[19] Coimbra Univ Hosp Ctr, Coimbra, Portugal

[20] Univ Hosp Salamanca, Salamanca, Spain

[21] Asklepios Hosp Hamburg, Hamburg, Germany

[22] Univ Hosp Bonn, Bonn, Germany

[23] Seattle Heart & Vasc, Seattle, WA USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2016年 / 207卷

关键词：

Left atrial appendage; Stroke; Bleeding; Renal failure; Amplatzer cardiac plug; GLOMERULAR-FILTRATION-RATE; WARFARIN THERAPY; ALL-CAUSE; RISK; CLOSURE; THROMBOEMBOLISM; ALBUMINURIA; BENEFIT;

D O I：

10.1016/j.ijcard.2016.01.003

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Left atrial appendage occlusion (LAAO) using the Amplatzer cardiac plug (ACP) is a preventive treatment of atrial fibrillation related thromboembolism. Aim: To assess the safety and efficacy of LAAO in patients with chronic kidney disease (CKD). Methods: Among the ACP multicentre registry, 1014 patients (75 +/- 8 yrs) with available renal function were included. Results: Patients with CKD (N = 375, CHA2DS2-VASc: 4.9 +/- 1.5, HASBLED: 3.4 +/- 1.3) were at higher risk than patients without CKD (N = 639, CHA2DS2-VASc: 4.2 +/- 1.6, HASBLED: 2.9 +/- 1.2; p < 0.001 for both). Procedural (97%) and occlusion (99%) success were similarly high in all stages of CKD. Peri-procedural major adverse events (MAE) were observed in 5.1% of patients, 0.8% of death, with no difference between patients with and those without CKD (6.1 vs 4.5%, p = 0.47). In patients with complete follow-up (1319 patients years), the annual stroke + transient ischaemic attack (TIA) rate was 2.3% and the observed bleeding rate was 2.1% (62 and 60% less than expected, similarly among patients with and those without CKD). Kaplan-Meier analysis showed a lower overall survival (84 vs 96% and 84 vs 93% at 1 and 2 yrs. respectively; p < 0.001) among patients with an eGFR <30 ml/min/1.73 m(2). Conclusion: LAAO using the ACP has a similar procedural safety among CKD patients compared to patients with normal renal function. LAAO with ACP offers a dramatic reduction of stroke + TIA rate and of bleeding rate persistent in all stages of CKD, as compared to the expected annual risk. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

引用

页码：335 / 340

页数：6

共 29 条

[1]

[Anonymous], 2010, EUROINTERVENTION, V6, P220

[2] Percutaneous Left Atrial Appendage Occlusion for Patients in Atrial Fibrillation Suboptimal for Warfarin Therapy 5-Year Results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study [J].

Block, Peter C. ;

Burstein, Steven ;

Casale, Paul N. ;

Kramer, Paul H. ;

Teirstein, Paul ;

Williams, David O. ;

Reisman, Mark .

JACC-CARDIOVASCULAR INTERVENTIONS, 2009, 2 (07) :594-600

[3] Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial Fibrillation and Chronic Kidney Disease A Nationwide Observational Cohort Study [J].

Bonde, Anders Nissen ;

Lip, Gregory Y. H. ;

Kamper, Anne-Lise ;

Hansen, Peter Riis ;

Lamberts, Morten ;

Hommel, Kristine ;

Hansen, Morten Lock ;

Gislason, Gunnar Hilmar ;

Torp-Pedersen, Christian ;

Olesen, Jonas Bjerring .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2014, 64 (23) :2471-2482

[4] 2012 focused update of the ESC Guidelines for the management of atrial fibrillation [J].

Camm, A. John ;

Lip, Gregory Y. H. ;

De Caterina, Raffaele ;

Savelieva, Irene ;

Atar, Dan ;

Hohnloser, Stefan H. ;

Hindricks, Gerhard ;

Kirchhof, Paulus ;

Bax, Jeroen J. ;

Baumgartner, Helmut ;

Ceconi, Claudio ;

Dean, Veronica ;

Deaton, Christi ;

Fagard, Robert ;

Funck-Brentano, Christian ;

Hasdai, David ;

Hoes, Arno ;

Knuuti, Juhani ;

Kolh, Philippe ;

McDonagh, Theresa ;

Moulin, Cyril ;

Popescu, Bogdan A. ;

Reiner, Zeljko ;

Sechtem, Udo ;

Sirnes, Per Anton ;

Tendera, Michal ;

Torbicki, Adam ;

Vahanian, Alec ;

Windecker, Stephan ;

Vardas, Panos ;

Al-Attar, Nawwar ;

Alfieri, Ottavio ;

Angelini, Annalisa ;

Blomstrom-Lundqvist, Carina ;

Colonna, Paolo ;

De Sutter, Johan ;

Ernst, Sabine ;

Goette, Andreas ;

Gorenek, Bulent ;

Hatala, Robert ;

Heidbuchel, Hein ;

Heldal, Magnus ;

Kristensen, Steen Dalby ;

Le Heuzey, Jean-Yves ;

Mavrakis, Hercules ;

Mont, Lluis ;

Filardi, Pasquale Perrone ;

Ponikowski, Piotr ;

Prendergast, Bernard ;

Rutten, Frans H. .

EUROPEAN HEART JOURNAL, 2012, 33 (21) :2719-2747

[5] Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].

Connolly, Stuart J. ;

Ezekowitz, Michael D. ;

Yusuf, Salim ;

Eikelboom, John ;

Oldgren, Jonas ;

Parekh, Amit ;

Pogue, Janice ;

Reilly, Paul A. ;

Themeles, Ellison ;

Varrone, Jeanne ;

Wang, Susan ;

Alings, Marco ;

Xavier, Denis ;

Zhu, Jun ;

Diaz, Rafael ;

Lewis, Basil S. ;

Darius, Harald ;

Diener, Hans-Christoph ;

Joyner, Campbell D. ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151

[6] Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study [J].

Go, Alan S. ;

Fang, Margaret C. ;

Udaltsova, Natalia ;

Chang, Yuchiao ;

Pomernacki, Niela K. ;

Borowsky, Leila ;

Singer, Daniel E. .

CIRCULATION, 2009, 119 (10) :1363-1369

[7] Apixaban versus Warfarin in Patients with Atrial Fibrillation [J].

Granger, Christopher B. ;

Alexander, John H. ;

McMurray, John J. V. ;

Lopes, Renato D. ;

Hylek, Elaine M. ;

Hanna, Michael ;

Al-Khalidi, Hussein R. ;

Ansell, Jack ;

Atar, Dan ;

Avezum, Alvaro ;

Cecilia Bahit, M. ;

Diaz, Rafael ;

Easton, J. Donald ;

Ezekowitz, Justin A. ;

Flaker, Greg ;

Garcia, David ;

Geraldes, Margarida ;

Gersh, Bernard J. ;

Golitsyn, Sergey ;

Goto, Shinya ;

Hermosillo, Antonio G. ;

Hohnloser, Stefan H. ;

Horowitz, John ;

Mohan, Puneet ;

Jansky, Petr ;

Lewis, Basil S. ;

Luis Lopez-Sendon, Jose ;

Pais, Prem ;

Parkhomenko, Alexander ;

Verheugt, Freek W. A. ;

Zhu, Jun ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (11) :981-992

[8] Comparisons between Novel Oral Anticoagulants and Vitamin K Antagonists in Patients with CKD [J].

Harel, Ziv ;

Sholzberg, Michelle ;

Shah, Prakesh S. ;

Pavenski, Katerina ;

Harel, Shai ;

Wald, Ron ;

Bell, Chaim M. ;

Perl, Jeffrey .

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2014, 25 (03) :431-442

[9] Stroke Prevention in Atrial Fibrillation Patients With Chronic Kidney Disease [J].

Hart, Robert G. ;

Eikelboom, John W. ;

Brimble, K. Scott ;

McMurtry, M. Sean ;

Ingram, Alistair J. .

CANADIAN JOURNAL OF CARDIOLOGY, 2013, 29 (07) :S71-S78

[10] Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial [J].

Holmes, David R. ;

Reddy, Vivek Y. ;

Turi, Zoltan G. ;

Doshi, Shephal K. ;

Sievert, Horst ;

Buchbinder, Maurice ;

Mullin, Christopher M. ;

Sick, Peter .

LANCET, 2009, 374 (9689) :534-542

← 1 2 3 →