Favorable neurological outcome after ischemic cerebrovascular events in patients treated with percutaneous left atrial appendage occlusion compared with warfarin

Abstract

Objectives This study sought to investigate neurological disability after ischemic cerebrovascular events in patients treated with left atrial appendage (LAA) occlusion compared with those on warfarin. Background Prior studies demonstrated that cerebrovascular events after LAA occlusion in patients with nonvalvular atrial fibrillation (NVAF) is largely nondisabling. Methods From the 1,189 patients in the Korean LAA Occlusion and European Amplatzer Cardiac Plug Multi‐Center Registry, 24 patients who experienced ischemic cerebrovascular events after LAA occlusion were enrolled. The neurological outcomes were compared with those in 68 patients who experienced an ischemic cerebrovascular event while on warfarin (Yonsei Stroke Registry). A modified Rankin scale (mRS) score of 3–6 categorized the cerebrovascular event as disabling. The mRS at discharge and at 3 and 12 months postcerebrovascular event in the two groups was compared. Results The percentages of disabling cerebrovascular events were 37.5% and 58.8% at discharge (P = 0.07), 20.8% and 42.6% at 3 months (P = 0.08), and 12.5% and 39.7% at 12 months (P = 0.02) in the LAA occlusion and warfarin groups, respectively. The mRS was significantly lower in the LAA occlusion group at discharge and at 3 months (P < 0.01) and 12 months (P < 0.01) postcerebrovascular event despite no significant difference in mRS before cerebrovascular events (P = 0.98). Patients in the LAA occlusion group demonstrated a significant reduction in mRS between discharge and 12 months (P < 0.01), unlike patients in the warfarin group (P = 0.10). Conclusions Ischemic cerebrovascular events in patients who previously underwent percutaneous LAA occlusion for NVAF were more favorable than in patients on warfarin.

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

“…7)9) More recently, we reported that NVAF patients previously treated with LAAO experienced more favorable outcomes following ischemic cerebrovascular events than patients taking warfarin. 8) The prevalence of disabling ischemic…”

“…6) Recent studies have reported less disabling and lethal strokes after percutaneous LAAO with the Amplatzer cardiac plug (ACP; Abbott Vascular, St. Paul, MN, USA) or Watchman device (Boston Scientific, Marlborough, MA, USA) than those in patients on warfarin therapy. [7][8][9] However, no comparative data regarding ischemic cerebrovascular eventassociated neurological outcomes following percutaneous LAA closure or NOAC treatment are…”

Indications for percutaneous left atrial appendage occlusion in hospitalized patients with atrial fibrillation

“…31,32 Moreover, patients who experienced ischemic cerebrovascular events during follow-up had more favorable neurological and functional outcomes if treated with LAAO compared with those treated with warfarin. 33 Furthermore, in patients with CKD treated with LAAO, even in those with eGFR less than 15 ml/min/1.73 m 2 , a significant reduction of almost 60% was observed in stroke/TIA rate and major bleeding rate in comparison with the expected annual risk. 34 Another critical aspect in the area of atrial fibrillation treatment is the adherence to anticoagulant agents.…”

Left Atrial Appendage Closure Yields Favorable Cardio- and Cerebrovascular Outcomes in Patients With Non-valvular Atrial Fibrillation and Prior Stroke

“…It is conceivable that patients with prior stroke may benefit more from LAAC in decreasing stroke recurrence than those without prior stroke. This could be because patients with AF who underwent LAAC exhibited a significantly reduced risk of disabling cerebrovascular outcome after ischemic cerebrovascular events in contrast to oral warfarin treatment ( 28 ), and LAAC delivered more quality-adjusted life years as well as more cost-effectiveness relative to NOACs for secondary prevention of stroke in AF patients ( 29 ).…”