AimsTo evaluate outcomes of percutaneous left atrial appendage closure (LAAC) in patients with congestive heart failure (CHF) and non-valvular atrial fibrillation (AF) in a consecutive, industry-independent registry associated with periprocedural success and complications during long-term follow-up. Methods and resultsFor this analysis, we included patients who underwent transcatheter LAAC from January 2014 to December 2019 at the University Heart Center in Lübeck, Germany, and compared patients with presence of CHF defined as patients with a reduced left ventricular ejection fraction (LVEF ≤ 40%), patients with a mid-range LVEF (LVEF 41-49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right-sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion < 17) to patients undergoing LAAC with no CHF. Primary endpoints were defined as periprocedural complications, and complications during long-term follow-up presented as major adverse cardiac and cerebrovascular events (MACCE). A total of 300 consecutive patients underwent LAAC. Of these, 96 patients in the CHF group were compared with 204 patients in the non-CHF group. Implantation success was lower in CHF group in comparison with non-CHF group (99.5% vs. 96%, P = 0.038); otherwise, there were no differences in periprocedural complications between groups. Patients with CHF showed a significantly higher incidence of MACCE rate (31.9% vs. 15.1%, P = 0.002) and more deaths (24.2% vs. 7%, P ≤ 0.001) during long-term follow-up. In Cox multivariable regression analysis, CHF was an independent predictor of mortality after LAAC implantation at long-term follow-up (hazard ratio 3.23, 95% confidence intervals 1.52-6.86, P = 0.002). Conclusions Implantation of LAAC devices in patients with non-valvular AF and CHF is safe. The increased mortality in patients with CHF compared with patients without CHF during the long-term follow-up is mainly attributed to comorbidities associated with CHF.

Background: Serum uric acid (SUA) has been correlated with cardiac morbidity and mortality. However, its prognostic value in acute ST-segment elevation myocardial infarction (STEMI) is still uncertain. The aim of this study was to evaluate the prognostic value of SUA on admission in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods: We prospectively enrolled 150 STEMI patients underwent PPCI. The mean age of the studied population was 56.1 years, 78% were males while 22% were females. Patients were divided into tertiles based on the basal serum uric acid level. Patients with high SUA (n = 72) was defined as a value in the third tertile (>6.4 mg/dl), and a low SUA group (n = 78) was set as a value in the lower two tertiles (<6.4 mg/dl). Clinical characteristics, angiographic findings, echocardiographic data, in-hospital and three-month outcomes of PPCI were analyzed. Results: SUA level on admission carried prognostic value in patients with STEMI undergoing PPCI where the low uric acid group had better KILLIP class (P = 0.001), better TIMI flow (P = 0.001), higher ejection fraction (49.53 ± 8.75 versus 39.95 ± 7.06; P = 0.001), better survival and lower incidence of other major adverse cardiac events (MACE) (P = 0.01) during the hospital stay and three months follow up than the high uric acid group. Age, SUA > 6 mg/dl, TIMI flow, Killip class and EF < 40% were independent predictors for MACE in such patients. Conclusions: High SUA level on admission was associated with higher frequency of in-hospital and three months follow up MACE in patients with acute STEMI undergoing PPCI.