Effect of Glomerular Filtration Rates on Outcomes Following Percutaneous Left Atrial Appendage Closure
Por:
Faroux L., Cruz-González 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-Lladó C., Estevez-Loureiro R., Laricchia A., O'Hara G., Rodés-Cabau J.
Publicada:
1 ene 2021
Resumen:
Scarce data support the prescription of oral anticoagulation in patients with concomitant advanced chronic kidney disease (CKD) and atrial fibrillation, and left atrial appendage closure (LAAC) may provide a favorable risk-benefit ratio in this population. However, outcomes of LAAC in CKD patients are unknown. We aimed to investigate the impact of moderate-to-severe CKD on clinical outcomes following percutaneous LAAC. This was a multicenter study including 1094 patients who underwent LAAC. Moderate-to-severe CKD was defined as an eGFR<45 mL/min. Death, ischemic stroke, severe bleeding (=BARC 3a) and serious adverse event (SAE; composite of death, stroke or severe bleeding) were recorded. A total of 300 patients (27.4%) had moderate-to-severe CKD. There were no differences between groups in periprocedural complications or device related thrombosis. At a median follow-up of 2 (1 to 3) years, patients with moderate-to-severe CKD did not present an increased risk of ischemic stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.22 to 1.92; p = 0.435) but were at a higher risk of death (HR: 2.84; 95% CI: 2.22 to 3.64; p <0.001), severe bleeding (HR: 1.96; 95% CI: 1.36 to 2.81; p <0.001) and SAE (HR: 2.23; 95% CI: 1.80 to 2.77; p <0.001). By multivariable analysis, an eGFR<45 ml/min (HR: 1.92; 95% CI: 1.34 to 2.76; p <0.001) and previous bleeding (HR: 2.30; 95% CI: 1.27 to 4.17; p = 0.006) were associated with an increased risk of severe bleeding. In conclusion, patients with moderate-to-severe CKD who underwent LAAC had very high thrombotic and bleeding risks. Although the rates of device related thrombosis or ischemic stroke after-LAAC were not influenced by kidney dysfunction, patients with moderate-to-severe CKD remained at higher risk of severe bleeding events. © 2021 Elsevier Inc.
Filiaciones:
Faroux L.:
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
Cruz-González I.:
University Hospital Salamanca, Salamanca, Spain
Arzamendi D.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Freixa X.:
Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
Nombela-Franco L.:
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
Peral V.:
Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
Caneiro-Queija B.:
University Hospital Alvaro Cunqueiro, Vigo, Spain
Mangieri A.:
GVM care and research, Maria Cecilia Hospital, Cotignola, Italy
Trejo-Velasco B.:
University Hospital Salamanca, Salamanca, Spain
Asmarats L.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Regueiro A.:
Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
McInerney A.:
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
Mas-Lladó C.:
Department of Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
Estevez-Loureiro R.:
University Hospital Alvaro Cunqueiro, Vigo, Spain
Laricchia A.:
GVM care and research, Maria Cecilia Hospital, Cotignola, Italy
O'Hara G.:
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
Rodés-Cabau J.:
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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