Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation

Abstract

Objectives To investigate periprocedural and long‐term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre‐procedural stroke risk. Background LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre‐procedural stroke risk may affect procedural and long‐term clinical outcome after LAAC is unclear. Methods Multicenter study of consecutive patients who underwent Amplatzer‐LAAC. Using pre‐procedural CHADS2 score, outcomes were compared between a low (0–2 points) and a high stroke risk group (3–6 points). Results Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer‐LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low‐risk group) and the remaining 252 patients had 3–6 points (high‐risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device‐related complications or major para‐device leaks: 89.4% vs. 87.9%, p = .74), and 30‐day‐mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient‐years (PY), the long‐term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%‐CI, 1.28–3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life‐threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%‐CI, 0.66–2.20, p = .52). Conclusions Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high‐risk patients in our study.

The Effect of Peri-Device Leaks on Ischaemic Stroke/Transient Ischaemic Attack/Systemic Embolism after Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis

“…The main cause of PDLs is a mismatch between the left atrial appendage and the closure device [11]. Although evidence suggests that patients in the ischaemic stroke/transient ischaemic attacks (TIAs)/systemic embolism (SE) group have a higher likelihood of PDL [12], the relationship between the occurrence of embolism events and PDL is still a topic of debate. This article aimed to evaluate the combination of ischaemic stroke/TIA/SE and PDL after LAAC.…”