Left Atrial Appendage Closure for Patients With a History of Ischemic Stroke Despite Oral Anticoagulant.

BACKGROUND

Patients who have an ischemic stroke (IS) with an oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (AF) who have had an IS despite OAC.

OBJECTIVES

The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.

METHODS

This study was retrospective observational study from the OCEAN-LAAC (Optimized Catheter Valvular Intervention-Left Atrial Appendage Closure) registry. Nonvalvular AF patients who underwent LAAC were divided into 3 groups: a control group with no IS history, a group having a previous IS despite an OAC, and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.

RESULTS

We included 1,418 patients (median CHA2DS2-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under an OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the 3 groups (previous IS despite OAC, subdistribution HR [sHR]: 1.78; 95% CI: 0.87-3.64; previous IS without OAC, sHR: 1.45; 95% CI: 0.59-3.55). The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR: 2.62; 95% CI: 1.17-5.86; Gray's test: P = 0.02; previous IS without OAC: sHR: 1.24; 95% CI: 0.36-4.28; Gray's test: P = 0.70).

CONCLUSIONS

The patients after LAAC who have had an IS despite OAC did not differ in CV death but were at higher risk of IS even after LAAC.