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

Abstract

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 endstage 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. K E Y W O R D Sinterventional left atrial appendage occlusion, logistic EuroSCORE II, mid-term mortality, risk stratification

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

“…In this analysis, dialysis patients were merged with those with stage 4 and 5 CKD not on dialysis and a significant reduction in stroke and bleeding compared to the expected annual risk was observed. Recently, Gotzmann et al retrospectively analysed 128 patients and showed that the incidence of mortality, bleeding or thromboembolism was not significantly higher in the subgroup of 33 patients with ESRD [ 21 ].…”

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

“…Gotzmann and colleagues retrospectively analyzed 128 candidates of LAAC. Of them, mortality, bleeding incidence, and thromboembolic events incidence were not statistically different between 33 hemodialysis patients and others [ 20 ]. In another study, renal impairment was associated with higher in-hospital mortality, longer hospital stay, and a higher 30-day readmission rate [ 21 ].…”