Risk stratification in patients undergoing interventional left atrial appendage occlusion-Prognostic impact of EuroSCORE II.

BACKGROUND

Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.

HYPOTHESIS: The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients.

METHODS

This study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all-cause mortality. Secondary endpoints were thromboembolic events and severe bleeding.

RESULTS

During a follow-up of 781 ± 498 days the primary endpoint (all-cause mortality) was reached in 35 patients (27%). The only independent predictor of mid-term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599-12.966, P = .005). In our study, 33 patients (26%) suffered from end-stage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613).

CONCLUSIONS

In patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information. This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome.