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October 3, 2022BMC Cardiovascular DisordersOpen Access

Left atrial appendage closure in nonvalvular atrial fibrillation patients with percutaneous coronary intervention

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Key result

In patients with nonvalvular atrial fibrillation undergoing left atrial appendage closure, those with prior percutaneous coronary intervention had similar rates of stroke or transient ischemic attack (2.8% vs 5.5%) compared to those without.

Why the study?

Antithrombotic therapy for nonvalvular atrial fibrillation patients with percutaneous coronary intervention remains contradictory and challenging, prompting assessment of left atrial appendage closure.

Does left atrial appendage closure (LAAC) safely prevent thromboembolic and bleeding events in nonvalvular atrial fibrillation patients with prior percutaneous coronary intervention compared to those without?

Population

109 patients with NVAF undergoing LAAC

Comparison

Patients with PCI vs patients without PCI

Design

Retrospective cohort study

Follow-up

Median 20.9 months

Authors

YYYunan YuJXJing XuLWLiang Wang

Discussion

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Overview

LAAC may be considered for stroke prevention in NVAF-PCI patients; leaves open need for randomized confirmation before practice change.

Study Design

Type

Cohort (n=109)

Multicenter

Yes

Structured PICO

Does left atrial appendage closure (LAAC) safely prevent thromboembolic and bleeding events in nonvalvular atrial fibrillation patients with prior percutaneous coronary intervention compared to those without?

P
Population
109 patients with nonvalvular atrial fibrillation who underwent successful left atrial appendage closure, including 36 with prior percutaneous coronary intervention, followed for a median of 20.9 months.
E
Exposure
Left atrial appendage closure (LAAC) in NVAF patients with a history of percutaneous coronary intervention (PCI).
C
Comparator
Left atrial appendage closure (LAAC) in NVAF patients without a history of percutaneous coronary intervention (PCI).
O
Outcome
Peri-procedural and long-term complications, as well as ischemia and bleeding events over a median follow-up of 20.9 months.hard clinical

Main Result

Absolute Event Rate: 2.8% vs 5.5%

p-value: p=1.000

LAAC is a safe and effective option for stroke prevention in NVAF patients with a history of PCI, demonstrating comparable long-term outcomes to those without PCI.

Limitations

  • Small sample size
  • Retrospective, non-randomized design
  • Did not analyze differences by time from previous PCI
  • Potential subjective bias from phone follow-up
  • Sample size was relatively small and it was not a randomized trial.
  • Did not analyze the differences by the time from the previous PCI.
  • Last follow-up using phone contact was prone to subjective bias.

Cite This Study

Yu et al. (2022) conducted a cohort in Nonvalvular atrial fibrillation (n=109). Prior percutaneous coronary intervention vs. No prior percutaneous coronary intervention was evaluated on Stroke/transient ischemic attack (p=1.000). In patients with nonvalvular atrial fibrillation undergoing left atrial appendage closure, those with prior percutaneous coronary intervention had similar rates of stroke or transient ischemic attack (2.8% vs 5.5%) compared to those without.

synapsesocial.com/papers/6a74bbb70081fe7b05dbe6d1https://doi.org/10.1186/s12872-022-02865-6
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry2020 · 9 citations
  2. 2Device-Related Thrombosis After Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation2018 · 362 citations
  3. 3Left Atrial Appendage Occlusion in High Bleeding Risk Patients2019 · 23 citations
  4. 4Evaluating Real-World Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology2019 · 289 citations
  5. 5Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry2016 · 525 citations