Format

Send to

Choose Destination
Rev Esp Cardiol (Engl Ed). 2019 Jun;72(6):449-455. doi: 10.1016/j.rec.2018.03.017. Epub 2018 May 10.

Long-term Event Reduction After Left Atrial Appendage Closure. Results of the Iberian Registry II.

[Article in English, Spanish]

Author information

1
Servicio de Cardiología, Hospital Infanta Cristina, Badajoz, Spain. Electronic address: lopez-minguez@hotmail.com.
2
Servicio de Cardiología, Hospital Infanta Cristina, Badajoz, Spain.
3
Serviço de Cardiologia, Hospital de Santa María, Lisboa, Portugal.
4
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Oporto, Portugal.
5
Servicio de Cardiología, Hospital Virgen de la Macarena, Sevilla, Spain.
6
Servicio de Cardiología, Hospital Santa Creu i San Pau, Barcelona, Spain.
7
Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
8
Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain.
9
Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
10
Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain.
11
Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain.
12
Servicio de Cardiología, Hospital La Paz, Madrid, Spain.
13
Servicio de Cardiología, Hospital La Princesa, Madrid, Spain.
14
Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality.

METHODS:

Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up.

RESULTS:

A total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA2DS2-VASc; P < .001); intracranial hemorrhage 0.8%; gastrointestinal bleeding 3.2%; severe bleeding 3.9% (vs 6.3% expected by HAS-BLED, P = .002). These results were improved in the subgroup of 176 patients with follow-up > 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P < .033). The factors significantly associated with higher mortality were age (HR, 1.1), intracranial hemorrhage (HR, 6.8), and stroke during follow-up (HR, 2.7).

CONCLUSIONS:

Left atrial appendage closure significantly reduced the incidence of stroke and bleeding events and the benefit was maintained. Intracranial hemorrhage, age and stroke were associated with higher mortality.

KEYWORDS:

Bleeding; Cierre de orejuela izquierda; Fibrilación auricular no valvular; Hemorragia; Ictus; Left atrial appendage closure; Mortalidad; Mortality; Nonvalvular atrial fibrillation; Stroke

PMID:
29754808
DOI:
10.1016/j.rec.2018.03.017

Supplemental Content

Full text links

Icon for Ediciones Doyma, S.L.
Loading ...
Support Center