Key result
CKD is linked to ~11% lower 1-year survival free of death and stroke following LAAC.
Why the study?
Although chronic kidney disease is prevalent among atrial fibrillation patients, its impact on periprocedural complications and outcomes after interventional left atrial appendage closure is unclear.
Does chronic kidney disease affect the safety and efficacy of left atrial appendage closure in patients with atrial fibrillation?
Observational (n=623)
Yes
Does chronic kidney disease affect the safety and efficacy of left atrial appendage closure in patients with atrial fibrillation?
Absolute Event Rate: 82% vs 93%
p-value: p=<0.001
Left atrial appendage closure is safe and provides effective stroke prevention across all stages of chronic kidney disease, despite these patients having a higher baseline cardiovascular risk and lower overall survival free of stroke.
Supports LAA closure in CKD despite higher risks; extends observational data but leaves open need for randomized confirmation.
Objectives Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure’s effectiveness and safety. Methods LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m 2 , and subgroups were further analysed (i.e. eGFR < 15, 15–29, and 30–59 mL/min/1.73 m 2 , respectively). Results Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA 2 DS 2 -VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m 2 ; p > 0.05 vs. eGFR 30–59 mL/min/1.73 m 2 ). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021). Conclusions Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.
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Fastner et al. (2020) conducted an observational in Atrial fibrillation (n=623). Chronic kidney disease vs. No chronic kidney disease was evaluated on Absence of all-cause death and stroke (p=<0.001). Chronic kidney disease was associated with a lower 1-year survival free of all-cause death and stroke (82.0% vs. 93.0%, p<0.001) compared to normal renal function in patients undergoing left atrial appendage closure.