TY - JOUR
T1 - Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion
AU - Della Rocca, Domenico G.
AU - Magnocavallo, Michele
AU - Van Niekerk, Christoffel J.
AU - Gilhofer, Thomas
AU - Ha, Grace
AU - D'Ambrosio, Gabriele
AU - Mohanty, Sanghamitra
AU - Gianni, Carola
AU - Galvin, Jennifer
AU - Vetta, Giampaolo
AU - Lavalle, Carlo
AU - Di Biase, Luigi
AU - Sorgente, Antonio
AU - Chierchia, Gian Battista
AU - De Asmundis, Carlo
AU - Urbanek, Lukas
AU - Schmidt, Boris
AU - Geller, J. Christoph
AU - Lakkireddy, Dhanunjaya R.
AU - Mansour, Moussa
AU - Saw, Jacqueline
AU - Horton, Rodney P.
AU - Gibson, Douglas
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Aims: Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results: A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. Conclusion: Patients with moderate-To-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
AB - Aims: Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results: A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. Conclusion: Patients with moderate-To-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
KW - Atrial fibrillation
KW - Chronic kidney disease
KW - Left atrial appendage
KW - Stroke
KW - Watchman
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U2 - 10.1093/europace/euad315
DO - 10.1093/europace/euad315
M3 - Article
C2 - 37889200
AN - SCOPUS:85178497928
SN - 1099-5129
VL - 25
JO - Europace
JF - Europace
IS - 11
M1 - euad315
ER -