RT Journal Article
SR Electronic
T1 Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 877
OP 883
DO 10.1136/heartjnl-2014-306332
VO 101
IS 11
A1 López Mínguez, José Ramón
A1 Nogales Asensio, Juan Manuel
A1 Gragera, Javier Elduayen
A1 Costa, Marco
A1 Cruz González, Ignacio
A1 Gimeno de Carlos, Federico
A1 Fernández Díaz, José Antonio
A1 Martín Yuste, Victoria
A1 Moreno González, Raúl
A1 Domínguez-Franco, Antonio
A1 Benedicto Buendía, Amparo
A1 Herrero Garibi, Jesús
A1 Hernández Hernández, Felipe
A1 Gama Ribeiro, Vasco
YR 2015
UL http://heart.bmj.com/content/101/11/877.abstract
AB 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.