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

详细信息    查看全文

• 作者：Joelle Kefer^a ; ^{joelle.kefer@uclouvain.be" class="auth_mail" title="E-mail the corresponding author} ; Apostolos Tzikas^b ; Xavier Freixa^c ; Samera Shakir^d ; Sameer Gafoor^e ; ^w ; Jens Erik Nielsen-Kudsk^f ; Sergio Berti^g ; Gennaro Santoro^h ; Adel Aminianⁱ ; Ulf Landmesser^j ; Fabian Nietlispach^d ; ^j ; Reda Ibrahim^k ; Paolo Luciano Danna^l ; Edouard Benit^m ; Werner Budtsⁿ ; Francis Stammen^o ; Tom De Potter^p ; Tobias Tichelbä ; cker^q ; Steffen Gloekler^d ; Prapa Kanagaratnam^r ; Marco Costa^s ; Ignacio Cruz-Gonzalez^t ; Horst Sievert^e ; Wolfgang Schillinger^q ; Jai-Wun Park^u ; Bernhard Meier^d ; Heyder Omran^v
• 关键词：Left atrial appendage ; Stroke ; Bleeding ; Renal failure ; Amplatzer cardiac plug
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 March 2016
• 年：2016
• 卷：207
• 期：Complete
• 页码：335-340
• 全文大小：398 K

文摘

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 m².

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.