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Title: | Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation | Authors: | Kefer, Joelle Tzikas, Apostolos Freixa, Xavier Shakir, Samera Gafoor, Sameer Nielsen-Kudsk, Jens Erik Berti, Sergio Santoro, Gennaro Aminian, Adel Landmesser, Ulf Nietlispach, Fabian Ibrahim, Reda Danna, Paolo Luciano BENIT, Edouard Budts, Werner Stammen, Francis De Potter, Tom Tichelbaecker, Tobias Gloekler, Steffen Kanagaratnam, Prapa Costa, Marco Cruz-Gonzalez, Ignacio Sievert, Horst Schillinger, Wolfgang Park, Jai-Wun Meier, Bernhard Omran, Heyder |
Issue Date: | 2016 | Source: | INTERNATIONAL JOURNAL OF CARDIOLOGY, 207, p. 335-340 | Abstract: | Background: Left atrial appendage occlusion (LAAO) using the Amplatzer cardiac plug (ACP) is a preventive treatment of atrial fibrillation related thromboembolism. Aim: To assess the safety and efficacy of LAAO in patients with chronic kidney disease (CKD). Methods: Among the ACP multicentre registry, 1014 patients (75 +/- 8 yrs) with available renal function were included. Results: Patients with CKD (N = 375, CHA2DS2-VASc: 4.9 +/- 1.5, HASBLED: 3.4 +/- 1.3) were at higher risk than patients without CKD (N = 639, CHA2DS2-VASc: 4.2 +/- 1.6, HASBLED: 2.9 +/- 1.2; p < 0.001 for both). Procedural (97%) and occlusion (99%) success were similarly high in all stages of CKD. Peri-procedural major adverse events (MAE) were observed in 5.1% of patients, 0.8% of death, with no difference between patients with and those without CKD (6.1 vs 4.5%, p = 0.47). In patients with complete follow-up (1319 patients years), the annual stroke + transient ischaemic attack (TIA) rate was 2.3% and the observed bleeding rate was 2.1% (62 and 60% less than expected, similarly among patients with and those without CKD). Kaplan-Meier analysis showed a lower overall survival (84 vs 96% and 84 vs 93% at 1 and 2 yrs. respectively; p < 0.001) among patients with an eGFR <30 ml/min/1.73 m(2). Conclusion: LAAO using the ACP has a similar procedural safety among CKD patients compared to patients with normal renal function. LAAO with ACP offers a dramatic reduction of stroke + TIA rate and of bleeding rate persistent in all stages of CKD, as compared to the expected annual risk. (C) 2016 Elsevier Ireland Ltd. All rights reserved. | Keywords: | left atrial appendage; stroke; bleeding; renal failure; amplatzer cardiac plug | Document URI: | http://hdl.handle.net/1942/26520 | ISSN: | 0167-5273 | e-ISSN: | 1874-1754 | DOI: | 10.1016/j.ijcard.2016.01.003 | ISI #: | 000371271400099 | Rights: | © 2016 Elsevier Ireland Ltd. All rights reserved. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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