Key result
Left atrial appendage occlusion was associated with a lower risk of mortality, ischaemic stroke, and major bleeding compared to standard medical care (HR 0.16; 95% CI 0.07-0.37).
Why the study?
Does left atrial appendage occlusion reduce the composite of all-cause mortality, ischaemic stroke, and major bleeding in patients with atrial fibrillation and previous intracerebral haemorrhage compared to standard medical care?
Cohort (n=302)
Yes
Does left atrial appendage occlusion reduce the composite of all-cause mortality, ischaemic stroke, and major bleeding in patients with atrial fibrillation and previous intracerebral haemorrhage compared to standard medical care?
Hazard Ratio: 0.16 (95% CI 0.07–0.37)
Absolute Event Rate: 53.3% vs 366.7%
Left atrial appendage occlusion may offer a major clinical benefit by reducing mortality, stroke, and bleeding in AF patients with a history of intracerebral hemorrhage compared to standard medical care.
May support LAAO in select AF patients; leaves open need for RCTs to confirm benefit.
AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the AMPLATZER Cardiac Plug or the AMPLATZER AMULET were compared to a propensity score-matched group of 151 patients receiving standard medical therapy. The two groups were matched so that their risks for stroke and bleeding were similar (CHA2DS2-VASc and HAS-BLED scores). The standard care patients were identified from the Danish Stroke Registry among 787 patients with AF and ICH. The primary endpoint was a composite of all-cause mortality, ischaemic stroke and major bleeding. Patients with AF and a prior ICH treated with LAAO had a lower risk of the composite outcome as compared to patients treated with standard medical care (events/1,000 years [95% confidence interval]: 53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]; hazard ratio 0.16 [0.07-0.37]). CONCLUSIONS: LAAO is suggested to be of major clinical benefit in AF patients having sustained an ICH. These results have to be confirmed in a randomised clinical trial.
No takes yet. Share an insight, caveat, or question.
Nielsen‐Kudsk et al. (2017) conducted a cohort in Atrial fibrillation and intracerebral haemorrhage (n=302). Left atrial appendage occlusion (LAAO) vs. Standard medical therapy was evaluated on Composite of all-cause mortality, ischaemic stroke and major bleeding (HR 0.16, 95% CI 0.07-0.37). Left atrial appendage occlusion was associated with a lower risk of mortality, ischaemic stroke, and major bleeding compared to standard medical care (HR 0.16; 95% CI 0.07-0.37).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: