Author + information
- Jose R. Lopez-Minguez1,
- Juan Manuel Nogales-Asensio1,
- Eduardo Infante De Oliveira2,
- Vasco De Gama-Ribeiro3,
- Rafael Ruiz-Salmeron4,
- Dabit Arzamendi-Aizpurua5,
- Marco Costa6,
- Hipolito Gutierrez-Garcia7,
- Jose Antonio Fernandez-Diaz8,
- Victoria Martin-Yuste9,
- Juan Carlos Rama-Merchan10,
- Raul Moreno11 and
- Fernando Alfonso-Manterola12
- 1Hospital Infanta Cristina, Badajoz, Spain
- 2Hospital Santa Maria, Lisbon, Portugal
- 3Centro Hospitalario de Vila Nova de Gaia, Oporto, Portugal
- 4Hospital Virgen de la Macarena, Seville, Spain
- 5Hospital Santa Creu i San Pau, Barcelona, Spain
- 6Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- 7Hospital Clínico de Valladolid, Valladolid, Spain
- 8Hospital Puerta de Hierro, Madrid, Spain
- 9Hospital Clínic de Barcelona, Barcelona, Spain
- 10Hospital Universitario de Salamanca, Salamanca, Spain
- 11Hospital La Paz, Madrid, Spain
- 12Hospital La Princesa, Madrid, Spain
Introduction and Objectives
Many patients with non-valvular atrial fibrillation (NVAF) are still left without protection due to a contraindication for anticoagulants (OACs). Although closure of left atrial appendage (LAA) can reduce the thromboembolic/bleeding events and mortality in these patients, a better understanding of their natural history is needed. This study aimed to establish the occurrence of stroke and major bleeding events in patients with NVAFand LAA closure with medium (<24 months) and long-term (>24 months) follow-up.
Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASC and HAS-BLED scores and according to follow-up duration. Multivariate analysis examined variables associated with mortality during follow-up.
A total of 598 patients with a contraindication for oral anticoagulants (OACs) were recruited (median 75.4 years). LAA closure device implantation success was 95.8%. Thirty patients (5%) experienced periprocedural complications. Results based on a <24- or >24-month follow-up: deaths: 13.1% vs. 4.6% (p<0.001); ischemic stroke: 2% vs. 1.5% (p=0.514;expected: 8.4%); intracranial hemorrhage: 1.7% vs. 0.4% (p=0.297); gastrointestinal bleeding: 7.9% vs. 1.2% (p<0.030);major bleeding: 7.6% vs. 2.6% (p<0.006;expected:6.3%). Age (HR 1.1), intracranial hemorrhage (HR 6.8) and stroke during follow-up (HR 2.7) were significantly associated with higher mortality.
LAA closure significantly reduced the incidence of stroke from the first year. Reduction of bleeding events became significant after longer follow-up. Intracranial hemorrhage, age and stroke during follow-up were associated with higher mortality.