Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long-term follow-up.
Catheter Cardiovasc Interv
; 103(3): 499-510, 2024 02.
Article
em En
| MEDLINE
| ID: mdl-38168895
ABSTRACT
INTRODUCTION AND OBJECTIVES:
Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD.METHODS:
Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022.RESULTS:
Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate at 1-year (HR 1.22, IC-95% 0.14-10.42, p = 0.861); at 5-years (HR 0.60, IC-95% 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR 1.34, IC-95% 0.63-2.88, p = 0.464) or at 5-years follow-up (HR 1.30, IC-95% 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR 1.84, IC-95% 1.18-2.87, p = 0.012).CONCLUSIONS:
LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Apêndice Atrial
/
Acidente Vascular Cerebral
/
Insuficiência Renal Crônica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Catheter Cardiovasc Interv
/
Catheter. cardiovasc. interv
/
Catheterization and cardiovascular interventions
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Espanha