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
em 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Apêndice Atrial
/
Hemorragia Gastrointestinal
Tipo de estudo:
Clinical_trials
/
Incidence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Pacing Clin Electrophysiol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Canadá