Медицинская библиотека · Journal of the American College of Cardiology · 2021

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion.

Simard Trevor, Jung Richard G, Lehenbauer Kyle, Piayda Kerstin, Pracoń Radoslaw, Jackson Gregory G, Flores-Umanzor Eduardo, Faroux Laurent, Korsholm Kasper, Chun Julian K R, Chen Shaojie, Maarse Moniek, Montrella Kristi, Chaker Zakeih, Spoon Jocelyn N, Pastormerlo Luigi E, Meincke Felix, Sawant Abhishek C, Moldovan Carmen M, Qintar Mohammed, Aktas Mehmet K, Branca Luca, Radinovic Andrea, Ram Pradhum, El-Zein Rayan S, Flautt Thomas, Ding Wern Yew, Sayegh Bassel, Benito-González Tomás, Lee Oh-Hyun, Badejoko Solomon O, Paitazoglou Christina, Karim Nabeela, Zaghloul Ahmed M, Agrawal Himanshu, Kaplan Rachel M, Alli Oluseun, Ahmed Aamir, Suradi Hussam S, Knight Bradley P, Alla Venkata M, Panaich Sidakpal S, Wong Tom, Bergmann Martin W, Chothia Rashaad, Kim Jung-Sun, Pérez de Prado Armando, Bazaz Raveen, Gupta Dhiraj, Valderrabano Miguel, Sanchez Carlos E, El Chami Mikhael F, Mazzone Patrizio, Adamo Marianna, Ling Fred, Wang Dee Dee, O'Neill William, Wojakowski Wojtek, Pershad Ashish, Berti Sergio, Spoon Daniel, Kawsara Akram, Jabbour George, Boersma Lucas V A, Schmidt Boris, Nielsen-Kudsk Jens Erik, Rodés-Cabau Josep, Freixa Xavier, Ellis Christopher R, Fauchier Laurent, Demkow Marcin, Sievert Horst, Main Michael L, Hibbert Benjamin, Holmes David R, Alkhouli Mohamad

СтатьяМногоцентровое исследованиеПеревод в очереди

Аннотация

BACKGROUND

Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.

OBJECTIVES

This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.

METHODS

Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT.

RESULTS

A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors.

CONCLUSIONS

DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Для цитирования: Simard Trevor, Jung Richard G, Lehenbauer Kyle, Piayda Kerstin, Pracoń Radoslaw, Jackson Gregory G, Flores-Umanzor Eduardo, Faroux Laurent, Korsholm Kasper, Chun Julian K R, Chen Shaojie, Maarse Moniek, Montrella Kristi, Chaker Zakeih, Spoon Jocelyn N, Pastormerlo Luigi E, Meincke Felix, Sawant Abhishek C, Moldovan Carmen M, Qintar Mohammed, Aktas Mehmet K, Branca Luca, Radinovic Andrea, Ram Pradhum, El-Zein Rayan S, Flautt Thomas, Ding Wern Yew, Sayegh Bassel, Benito-González Tomás, Lee Oh-Hyun, Badejoko Solomon O, Paitazoglou Christina, Karim Nabeela, Zaghloul Ahmed M, Agrawal Himanshu, Kaplan Rachel M, Alli Oluseun, Ahmed Aamir, Suradi Hussam S, Knight Bradley P, Alla Venkata M, Panaich Sidakpal S, Wong Tom, Bergmann Martin W, Chothia Rashaad, Kim Jung-Sun, Pérez de Prado Armando, Bazaz Raveen, Gupta Dhiraj, Valderrabano Miguel, Sanchez Carlos E, El Chami Mikhael F, Mazzone Patrizio, Adamo Marianna, Ling Fred, Wang Dee Dee, O'Neill William, Wojakowski Wojtek, Pershad Ashish, Berti Sergio, Spoon Daniel, Kawsara Akram, Jabbour George, Boersma Lucas V A, Schmidt Boris, Nielsen-Kudsk Jens Erik, Rodés-Cabau Josep, Freixa Xavier, Ellis Christopher R, Fauchier Laurent, Demkow Marcin, Sievert Horst, Main Michael L, Hibbert Benjamin, Holmes David R, Alkhouli Mohamad. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion.. Journal of the American College of Cardiology. 2021. DOI: 10.1016/j.jacc.2021.04.098.

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