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Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure
  1. José Ramón López Mínguez1,
  2. Juan Manuel Nogales Asensio1,
  3. Javier Elduayen Gragera1,
  4. Marco Costa2,
  5. Ignacio Cruz González3,
  6. Federico Gimeno de Carlos4,
  7. José Antonio Fernández Díaz5,
  8. Victoria Martín Yuste6,
  9. Raúl Moreno González7,
  10. Antonio Domínguez-Franco8,
  11. Amparo Benedicto Buendía9,
  12. Jesús Herrero Garibi10,
  13. Felipe Hernández Hernández11,
  14. Vasco Gama Ribeiro12
  1. 1Hospital Universitario Infanta Cristina, Badajoz, Spain
  2. 2Hospital de Coimbra, Coimbra, Portugal
  3. 3Hospital Universitario de Salamanca, Salamanca, Spain
  4. 4Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  5. 5Hospital Puerta de Hierro, Majadahonda, Spain
  6. 6Hospital Clínic de Barcelona, Barcelona, Spain
  7. 7Hospital Universitario La Paz, Madrid, Spain
  8. 8Hospital Virgen de la Victoria, Málaga, Spain
  9. 9Hospital de La Princesa, Madrid, Spain
  10. 10Hospital de Burgos, Burgos, Spain
  11. 11Hospital 12 de Octubre, Madrid, Spain
  12. 12Hospital de Oporto, Oporto, Portugal
  1. Correspondence to Dr José Ramón López Mínguez, Adelardo Covarsí n°1; 6.° D. Badajoz 06005, Spain; lopez-minguez{at}hotmail.com

Abstract

Aims The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared.

Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively).

Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

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