Key result
In patients undergoing left atrial appendage occlusion, chronic kidney disease was associated with similar stroke rates as non-CKD (2.3 vs 1.4 per 100 PY; p=1.000) but higher contrast-induced AKI (11.1% vs 0%; p=0.004).
Why the study?
Patients with CKD and atrial fibrillation have increased risks for stroke and bleeding under oral anticoagulation, prompting investigation of percutaneous LAAO as an alternative therapy.
Does percutaneous left atrial appendage occlusion have comparable efficacy and safety in CKD versus Non-CKD patients with atrial fibrillation and high bleeding risk?
Cohort (n=146)
Does percutaneous left atrial appendage occlusion have comparable efficacy and safety in CKD versus Non-CKD patients with atrial fibrillation and high bleeding risk?
Absolute Event Rate: 2.3% vs 1.4%
p-value: p=1.000
LAAO provides comparable stroke and bleeding prevention in AFib patients regardless of CKD status, though CKD patients have a higher risk of periprocedural contrast-induced AKI.
LAAO may provide comparable stroke and bleeding prevention in high-risk CKD patients; leaves open need for RCTs versus anticoagulation.
Background: Patients with chronic kidney disease (CKD) and atrial fibrillation have increased risks for stroke and bleeding under oral anticoagulation (OAC). We investigated an alternative therapy of percutaneous left atrial appendage occlusion (LAAO) in CKD patients in this study.Methods: Consecutive patients undergoing LAAO were included in a retrospective analysis and stratified for kidney function into CKD/Non-CKD groups (cutoff eGFR 60 ml/min). Procedural characteristics, in-hospital and follow-up events were analysed and compared between groups.Results: LAAO was performed in 146 patients (81 CKD; 65 Non-CKD), mean follow-up was 391 days. Groups differed in eGFR (40.1 (CKD) vs. 75.1 (Non-CKD) ml/min) and CHA2DS2VASc scores (4.65 ± 1.3 (CKD) vs. 4.06 ± 1.4 (Non-CKD)). Procedural success was 98.6%, contrast-induced acute kidney injury was significantly more frequent in CKD patients (11.1% vs. 0%; p = .004). Follow-up mortality was higher in CKD (10.5/100 PY vs. 4.2/100 PY; p = .156). Follow-up stroke rates were 2.3/100 (CKD) patient-years (PY) and 1.4/100 PY (Non-CKD) (p = 1.000), corresponding to a relative risk reduction (RRR) of 60% (all), 68% (CKD) and 71% (Non-CKD) compared to expected stroke rates. Follow-up major bleeding rates were 3.5/100 PY (CKD) and 4.2/100 PY (Non-CKD), corresponding to RRR of 57% (all), 61% (CKD) and 53% (Non-CKD) compared to OAC.Conclusions: Left atrial appendage occlusion shows comparable efficacy for stroke and bleeding prevention in CKD and Non-CKD patients. CKD patients experience more adverse events during follow-up and a significantly increased risk for periprocedural contrast-induced acute kidney injury.
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Brockmeyer et al. (2019) conducted a cohort in Atrial fibrillation and high bleeding risk (n=146). Chronic kidney disease (CKD) vs. Non-CKD was evaluated on Follow-up stroke rates (per 100 patient-years) (p=1.000). In patients undergoing left atrial appendage occlusion, chronic kidney disease was associated with similar stroke rates as non-CKD (2.3 vs 1.4 per 100 PY; p=1.000) but higher contrast-induced AKI (11.1% vs 0%; p=0.004).
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