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Int J Cardiol. 2016 Mar 15;207:335-40. doi: 10.1016/j.ijcard.2016.01.003. Epub 2016 Jan 9.

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

Author information

1
Cliniques universitaires Saint-Luc, Brussels, Belgium. Electronic address: joelle.kefer@uclouvain.be.
2
Interbalkan European Medical Center, Thessaloniki, Greece.
3
Hospital Clinic of University of Barcelona, Barcelona, Spain.
4
University Hospital of bern, Bern, Switzerland.
5
CardioVascular Center Frankfurt, Frankfurt, Germany; Seattle Heart and Vascular, Seattle, WA, USA.
6
Aarhus University Hospital, Skejby, Denmark.
7
Heart Hospital, Fondazione C.N.R. Regione Toscana, Massa, Italy.
8
Ospedale Careggi di Firenze, Florence, Italy.
9
Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
10
University Hospital of Zurich, Zurich, Switzerland.
11
University Hospital of bern, Bern, Switzerland; University Hospital of Zurich, Zurich, Switzerland.
12
Montreal Heart Institute, Montreal, Canada.
13
Ospedale Luigi Sacco, Milan, Italy.
14
Jessaziekenhuis, Hasselt, Belgium.
15
UZ Leuven, Leuven, Belgium.
16
AZ Delta Roeselare, Roeselare, Belgium.
17
OLV Ziekenhuis, Aalst, Belgium.
18
Universitätsmedizin Göttingen, Göttingen, Germany.
19
Imperial College Healthcare NHS Trust, London, United Kingdom.
20
Coimbra University Hospital Centre, Coimbra, Portugal.
21
University Hospital of Salamanca, Salamanca, Spain.
22
CardioVascular Center Frankfurt, Frankfurt, Germany.
23
Asklepios Hospital Hamburg, Hamburg, Germany.
24
University Hospital of Bonn, Bonn, Germany.

Abstract

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±8yrs) 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 2yrs. respectively; p<0.001) among patients with an eGFR <30ml/min/1.73m(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.

KEYWORDS:

Amplatzer cardiac plug; Bleeding; Left atrial appendage; Renal failure; Stroke

PMID:
26820363
DOI:
10.1016/j.ijcard.2016.01.003
[Indexed for MEDLINE]

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