Incidence and Predictors of Early Death in Patients Undergoing Percutaneous Left Atrial Appendage Closure
Por:
Mesnier, J, Cruz-Gonzalez, I, Arzamendi, D, Freixa, X, Nombela-Franco, L, Peral, V, Caneiro-Queija, B, Mangieri, A, Trejo-Velasco, B, Asmarats, L, Regueiro, A, McInerney, A, Mas-Llado, C, Estevez-Loureiro, R, Laricchia, A, O'Hara, G, Rodes-Cabau, J
Publicada:
1 sep 2022
Resumen:
BACKGROUND Left atrial appendage closure (LAAC) aims to prevent ischemic events in patients with atrial fibrillation. As a preventive procedure, early death after LAAC could render the procedure futile.
OBJECTIVES The authors sought to evaluate the incidence and factors associated with early death in LAAC recipients.
METHODS This was a multicenter study including consecutive patients undergoing LAAC in a 10-year period (2009-2019). Death was considered early when occurring in the first year after LAAC.
RESULTS A total of 807 patients (mean age 76 +/- 18 years, mean CHA(2)DS(2)-VASc score 4.5 +/- 11.5) were included. Early death occurred in 125 patients (15.5%). In the multivariable analysis, factors associated with early death after LAAC were older age HR: 1.03; 95% CI: 1.01-1.06 per year; P = 0.01), tower body mass index (HR: 0.92; 95% CI: 0.88-0.97 per 1 kg/m(2) increase; P < 0.001), diabetes (HR: 1.71; 95% CI: 1.19-2.47; P = 0.002), prior heart failure (HR: 1.74; 95% CI: 1.20-2.53; P = 0.001), and lower estimated glomerular filtration rate (HR: 1.09; 95% CI: 1.05-1.13 per 5 ml/min/1.73 m(2) decrease; P < 0.001). There was a stepwise increase in risk of early death within the first year of LAAC with the combination of different risk factors (up to 48.9% in the presence of >3 risk factors).
CONCLUSIONS In this multicenter international registry, close to 1 in 6 patients died within the first year of LAAC. Older age, tow body mass index, impaired estimated glomerular filtration rate, prior diabetes, and prior heart failure are independently associated with an increased risk. The risk of early death appeared to be prohibitive (similar to 50%) in the presence of >3 of these risk factors.
Filiaciones:
Mesnier, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4GS, Canada
Cruz-Gonzalez, I:
Univ Hosp Salamanca, Salamanca, Spain
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Freixa, X:
Inst dInvestigac Biomed August Pi & Sunyer IDIBAP, Inst Clin Cardiovasc, Hosp Clin, Barcelona, Spain
Nombela-Franco, L:
Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Peral, V:
Hosp Univ Son Espases HUSE, Inst Invest Sanitaria Illes Balears IdISBa, Dept Cardiol, Palma De Mallorca, Balearic Island, Spain
Caneiro-Queija, B:
Univ Hosp Alvaro Cunqueiro, Vigo, Spain
Mangieri, A:
Maria Cecilia Hosp, GVM Care & Res, Cotignola, Italy
Trejo-Velasco, B:
Univ Hosp Salamanca, Salamanca, Spain
Asmarats, L:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Regueiro, A:
Inst dInvestigac Biomed August Pi & Sunyer IDIBAP, Inst Clin Cardiovasc, Hosp Clin, Barcelona, Spain
McInerney, A:
Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Mas-Llado, C:
Hosp Univ Son Espases HUSE, Inst Invest Sanitaria Illes Balears IdISBa, Dept Cardiol, Palma De Mallorca, Balearic Island, Spain
Estevez-Loureiro, R:
Univ Hosp Alvaro Cunqueiro, Vigo, Spain
Laricchia, A:
Maria Cecilia Hosp, GVM Care & Res, Cotignola, Italy
O'Hara, G:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4GS, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4GS, Canada
Inst dInvestigac Biomed August Pi & Sunyer IDIBAP, Inst Clin Cardiovasc, Hosp Clin, Barcelona, Spain
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