Incidence, predictors, and clinical impact of bleeding recurrence in patients with prior gastrointestinal bleeding undergoing LAAC
Por:
Faroux, L, 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, Gonzalez, AM, Estevez-Loureiro, R, Laricchia, A, O'Hara, G, Rodes-Cabau, J
Publicada:
1 jul 2021
Ahead of Print:
1 jun 2021
Resumen:
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% CI:1.04-2.67; 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.
Filiaciones:
Faroux, L:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V4G5, Canada
Cruz-Gonzalez, I:
Univ Hosp Salamanca, Salamanca, Spain
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Freixa, X:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin, Inst Clin Cardiovasc, Barcelona, Spain
Nombela-Franco, L:
Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Peral, V:
Hosp Univ Son Espases, Hlth Res Inst Balearic Isl IdISBa, Cardiol Dept, Palma De Mallorca, Spain
Caneiro-Queija, B:
Univ Hosp Alvaro Cunqueiro, Vigo, Spain
Mangieri, A:
Maria Cecilia Hosp, GVMcare & Res, Cotignola, Italy
Trejo-Velasco, B:
Univ Hosp Salamanca, Salamanca, Spain
Asmarats, L:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Regueiro, A:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin, Inst Clin Cardiovasc, Barcelona, Spain
McInerney, A:
Hosp Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Gonzalez, AM:
Hosp Univ Son Espases, Hlth Res Inst Balearic Isl IdISBa, Cardiol Dept, Palma De Mallorca, Spain
Estevez-Loureiro, R:
Univ Hosp Alvaro Cunqueiro, Vigo, Spain
Laricchia, A:
Maria Cecilia Hosp, GVMcare & Res, Cotignola, Italy
O'Hara, G:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V4G5, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V4G5, Canada
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