Incidence, predictors, and clinical impact of bleeding recurrence in patients with prior gastrointestinal bleeding undergoing LAAC.
Pacing Clin Electrophysiol
; 44(7): 1216-1223, 2021 Jul.
Article
en En
| MEDLINE
| ID: mdl-34110038
ABSTRACT
BACKGROUND:
Gastrointestinal bleeding (GIB) is associated with a high recurrence rate and a prior GIB episode is common in real-world left atrial appendage closure (LAAC) recipients. The present study sought to evaluate the clinical characteristics and outcomes of patients with prior GIB undergoing LAAC, and to determine the factors associated with and clinical impact of GIB recurrence.METHODS:
Multicenter study including 277 consecutive patients who underwent percutaneous LAAC and had prior GIB. All-cause death, all bleeding, GIB recurrence, and clinical ischemic stroke were recorded.RESULTS:
After a median follow-up of 17 (interquartile range 6-37) months post-LAAC, the rates of death, bleeding, GIB recurrence, and ischemic stroke were 14.0 per 100 person-year (PY), 29.3 per 100 PY, 17.7 per 100 PY, and 1.1 per 100 PY, respectively. GIB recurrence occurred within 3 months post-LAAC in 55.8% of patients. A previous lower GIB (vs. upper or unclassified) (HR 1.76; 95% CI 1.09-2.82; p = .020) and eGFR < 45 mL/min (HR 1.70; 95% CI1.04-2.67; p = .033) determined an increased risk of GIB recurrence. By multivariable analysis, eGFR < 45 mL/min (HR 2.72; 95% CI 1.70-4.34; p < .001), GIB recurrence following LAAC (HR 2.15; 95% CI 1.33-3.46; p = .002), diabetes mellitus (HR 1.77; 95% CI 1.10-2.84; p = .018), and age (HR 1.06; 95% CI 1.03-1.10; p < .001) were associated with an increased mortality.CONCLUSIONS:
Patients with prior GIB undergoing LAAC exhibited a relatively low rate of GIB recurrence, and prior lower GIB and moderate-to-severe chronic kidney disease determined an increased risk. GIB recurrence was associated with an increased mortality.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Apéndice Atrial
/
Hemorragia Gastrointestinal
Tipo de estudio:
Clinical_trials
/
Incidence_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
/
Aged80
/
Female
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Humans
/
Male
Idioma:
En
Revista:
Pacing Clin Electrophysiol
Año:
2021
Tipo del documento:
Article
País de afiliación:
Canadá