TY - JOUR
T1 - Left atrial appendage closure in end-stage renal disease and hemodialysis
T2 - Data from a German multicenter registry
AU - Fink, Thomas
AU - Paitazoglou, Christina
AU - Bergmann, Martin W.
AU - Sano, Makoto
AU - Keelani, Ahmad
AU - Sciacca, Vanessa
AU - Saad, Mohammed
AU - Eitel, Charlotte
AU - Heeger, Christian Hendrik
AU - Skurk, Carsten
AU - Landmesser, Ulf
AU - Thiele, Holger
AU - Stiermaier, Thomas
AU - Fuernau, Georg
AU - Reil, Jan Christian
AU - Frey, Norbert
AU - Kuck, Karl Heinz
AU - Tilz, Roland R.
AU - Sandri, Marcus
AU - Eitel, Ingo
N1 - Publisher Copyright:
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2023/2/15
Y1 - 2023/2/15
N2 - Background: Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild-to-moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end-stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials. Objectives: The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD. Methods: Patients undergoing LAAC were collected in a German multicenter real-world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score-matched patients without severe CKD. ESRD was defined as a glomerular filtration rate < 15 ml/min/1.73 m2 or chronic hemodialysis treatment. Results: A total of 604 patients were analyzed, including 57 with ESRD and 57 propensity-matched patients. Overall, 596 endocardial and 8 epicardial LAAC procedures were performed. Frequency of major complications was 7.0% (42/604 patients) in the overall cohort, 8.8% (5/57 patients) in patients with ESRD, and 10.5% (6/57 patients) in matched controls (p = 0.75). The estimated event-free survival of the combined endpoint after 500 days was 90.7 ± 4.5% in patients with ESRD and 90.2 ± 5.5% in matched controls (p = 0.33). Conclusions: LAAC had comparable procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD.
AB - Background: Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild-to-moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end-stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials. Objectives: The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD. Methods: Patients undergoing LAAC were collected in a German multicenter real-world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score-matched patients without severe CKD. ESRD was defined as a glomerular filtration rate < 15 ml/min/1.73 m2 or chronic hemodialysis treatment. Results: A total of 604 patients were analyzed, including 57 with ESRD and 57 propensity-matched patients. Overall, 596 endocardial and 8 epicardial LAAC procedures were performed. Frequency of major complications was 7.0% (42/604 patients) in the overall cohort, 8.8% (5/57 patients) in patients with ESRD, and 10.5% (6/57 patients) in matched controls (p = 0.75). The estimated event-free survival of the combined endpoint after 500 days was 90.7 ± 4.5% in patients with ESRD and 90.2 ± 5.5% in matched controls (p = 0.33). Conclusions: LAAC had comparable procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD.
UR - http://www.scopus.com/inward/record.url?scp=85146971271&partnerID=8YFLogxK
U2 - 10.1002/ccd.30559
DO - 10.1002/ccd.30559
M3 - Journal articles
C2 - 36682074
AN - SCOPUS:85146971271
SN - 1522-1946
VL - 101
SP - 610
EP - 619
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 3
ER -