Key result
Patients with end-stage chronic kidney disease undergoing left atrial appendage occlusion had a significantly higher risk of the primary composite outcome compared to those with normal or mildly reduced renal function (HR 1.436, 95% CI 1.162-1.775, p=0.001).
Why the study?
AF and CKD often coexist, predisposing patients to increased risks of thrombo-embolism and haemorrhage, motivating an evaluation of the prognostic value of CKD in patients undergoing LAAO.
Does worsening chronic kidney disease severity increase the risk of adverse clinical outcomes in patients with non-valvular atrial fibrillation undergoing left atrial appendage occlusion?
Cohort (n=2,124)
Yes
Does worsening chronic kidney disease severity increase the risk of adverse clinical outcomes in patients with non-valvular atrial fibrillation undergoing left atrial appendage occlusion?
Answers are grounded in this paper and cite their sources.
LAAO is associated with a consistent relative risk reduction for thromboembolism and major bleeding across all CKD stages compared to expected rates, though patients with advanced CKD remain at a higher absolute and relative risk for composite cardiovascular outcomes.
AIMS: Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO). METHODS AND RESULTS: A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively. CONCLUSION: Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
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Rocca et al. (2023) conducted a cohort in Non-valvular atrial fibrillation with chronic kidney disease (n=2,124). Worsening chronic kidney disease (Stages 3, 4, 5) vs. CKD Stage 1+2 (eGFR ≥ 60 mL/min/1.73 m2) was evaluated on Composite of cardiovascular death, stroke, transient ischemic attack (TIA), peripheral embolism, and clinically significant bleeding (HR 1.436 (for CKD Stage 5 vs Stage 1+2), 95% CI 1.162-1.775, p=0.001). Patients with end-stage chronic kidney disease undergoing left atrial appendage occlusion had a significantly higher risk of the primary composite outcome compared to those with normal or mildly reduced renal function (HR 1.436, 95% CI 1.162-1.775, p=0.001).
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