Key result
LAAC during CABG linked to ~57% fewer deaths and strokes in hemodialysis patients with NSR.
Why the study?
Patients with end-stage renal disease on hemodialysis have a lifelong risk of atrial fibrillation-related stroke, motivating evaluation of concomitant left atrial appendage closure during CABG.
Does concomitant LAA closure during CABG reduce the composite of death and stroke in ESRD-HD patients with normal sinus rhythm?
Cohort (n=242)
Open-label
No
Does concomitant LAA closure during CABG reduce the composite of death and stroke in ESRD-HD patients with normal sinus rhythm?
Concomitant LAA closure during CABG significantly reduces the long-term risk of death and stroke in hemodialysis patients with normal sinus rhythm.
Answers are grounded in this paper and cite their sources.
Should not change practice in hemodialysis patients undergoing CABG; leaves open need for randomized confirmation of benefit.
BACKGROUND: Patients with end-stage renal disease on hemodialysis (ESRD-HD) have a lifelong risk of atrial fibrillation-related stroke. We compared clinical outcomes in ESRD-HD patients undergoing coronary artery bypass grafting (CABG) with and without concomitant left atrial appendage (LAA) closure. METHODS AND RESULTS: Of 2,783 consecutive patients undergoing isolated CABG between 2002 and 2020, 242 patients had ESRD-HD with sinus rhythm. The primary outcome was a composite of death and stroke. An inverse probability (IP)-weighted cohort was created based on the propensity score. The 2 IP-weighted groups had well-balanced baseline and surgical backgrounds, with an equivalent follow-up. Five-year stroke-free survival was significantly higher in patients with LAA closure (log-rank test, P=0.035). The adjusted hazard ratio of LAA closure for death and stroke was 0.43 (95% confidence interval [CI] 0.20-0.92; P=0.023). Competing risk analysis showed that LAA closure was significantly associated with a risk reduction of stroke (subhazard ratio 0.26; 95% CI 0.08-0.96; P=0.028). No significant difference was observed in adjusted risk ratios for reoperation for bleeding, new atrial fibrillation, 30-day mortality, and readmission for heart failure. CONCLUSIONS: Concomitant LAA closure during CABG can reduce the risk of death and stroke in ESRD-HD patients with normal sinus rhythm.
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Endo et al. (2023) conducted a cohort in End-stage renal disease on hemodialysis (ESRD-HD) with sinus rhythm undergoing coronary artery bypass grafting (n=242). Concomitant left atrial appendage (LAA) closure vs. Coronary artery bypass grafting (CABG) alone was evaluated on Composite of all-cause death and first occurrence of stroke (HR 0.43, 95% CI 0.20-0.92, p=0.023). Concomitant left atrial appendage closure during coronary artery bypass grafting significantly reduced the composite risk of death and stroke (HR 0.43) in hemodialysis patients with normal sinus rhythm.
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