Cargando…
Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion
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 appe...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653166/ https://www.ncbi.nlm.nih.gov/pubmed/37889200 http://dx.doi.org/10.1093/europace/euad315 |
_version_ | 1785136361903226880 |
---|---|
author | Della Rocca, Domenico G Magnocavallo, Michele Van Niekerk, Christoffel J Gilhofer, Thomas Ha, Grace D'Ambrosio, Gabriele Mohanty, Sanghamitra Gianni, Carola Galvin, Jennifer Vetta, Giampaolo Lavalle, Carlo Di Biase, Luigi Sorgente, Antonio Chierchia, Gian-Battista de Asmundis, Carlo Urbanek, Lukas Schmidt, Boris Geller, J Christoph Lakkireddy, Dhanunjaya R Mansour, Moussa Saw, Jacqueline Horton, Rodney P Gibson, Douglas Natale, Andrea |
author_facet | Della Rocca, Domenico G Magnocavallo, Michele Van Niekerk, Christoffel J Gilhofer, Thomas Ha, Grace D'Ambrosio, Gabriele Mohanty, Sanghamitra Gianni, Carola Galvin, Jennifer Vetta, Giampaolo Lavalle, Carlo Di Biase, Luigi Sorgente, Antonio Chierchia, Gian-Battista de Asmundis, Carlo Urbanek, Lukas Schmidt, Boris Geller, J Christoph Lakkireddy, Dhanunjaya R Mansour, Moussa Saw, Jacqueline Horton, Rodney P Gibson, Douglas Natale, Andrea |
author_sort | Della Rocca, Domenico G |
collection | PubMed |
description | 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 CHA(2)DS(2)-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. |
format | Online Article Text |
id | pubmed-10653166 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106531662023-10-27 Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion Della Rocca, Domenico G Magnocavallo, Michele Van Niekerk, Christoffel J Gilhofer, Thomas Ha, Grace D'Ambrosio, Gabriele Mohanty, Sanghamitra Gianni, Carola Galvin, Jennifer Vetta, Giampaolo Lavalle, Carlo Di Biase, Luigi Sorgente, Antonio Chierchia, Gian-Battista de Asmundis, Carlo Urbanek, Lukas Schmidt, Boris Geller, J Christoph Lakkireddy, Dhanunjaya R Mansour, Moussa Saw, Jacqueline Horton, Rodney P Gibson, Douglas Natale, Andrea Europace Clinical Research 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 CHA(2)DS(2)-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. Oxford University Press 2023-10-27 /pmc/articles/PMC10653166/ /pubmed/37889200 http://dx.doi.org/10.1093/europace/euad315 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Research Della Rocca, Domenico G Magnocavallo, Michele Van Niekerk, Christoffel J Gilhofer, Thomas Ha, Grace D'Ambrosio, Gabriele Mohanty, Sanghamitra Gianni, Carola Galvin, Jennifer Vetta, Giampaolo Lavalle, Carlo Di Biase, Luigi Sorgente, Antonio Chierchia, Gian-Battista de Asmundis, Carlo Urbanek, Lukas Schmidt, Boris Geller, J Christoph Lakkireddy, Dhanunjaya R Mansour, Moussa Saw, Jacqueline Horton, Rodney P Gibson, Douglas Natale, Andrea Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title | Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title_full | Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title_fullStr | Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title_full_unstemmed | Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title_short | Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
title_sort | prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653166/ https://www.ncbi.nlm.nih.gov/pubmed/37889200 http://dx.doi.org/10.1093/europace/euad315 |
work_keys_str_mv | AT dellaroccadomenicog prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT magnocavallomichele prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT vanniekerkchristoffelj prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT gilhoferthomas prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT hagrace prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT dambrosiogabriele prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT mohantysanghamitra prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT giannicarola prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT galvinjennifer prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT vettagiampaolo prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT lavallecarlo prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT dibiaseluigi prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT sorgenteantonio prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT chierchiagianbattista prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT deasmundiscarlo prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT urbaneklukas prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT schmidtboris prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT gellerjchristoph prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT lakkireddydhanunjayar prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT mansourmoussa prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT sawjacqueline prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT hortonrodneyp prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT gibsondouglas prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion AT nataleandrea prognosticvalueofchronickidneydiseaseinpatientsundergoingleftatrialappendageocclusion |