Key result
In patients with nonvalvular atrial fibrillation undergoing left atrial appendage closure, prior percutaneous coronary intervention did not alter the risk of stroke or transient ischemic attack compared to those without prior intervention.
Why the study?
Antithrombotic therapy for NVAF patients undergoing PCI remains contradictory and challenging, necessitating assessment of LAAC safety and efficacy in this population.
Does left atrial appendage closure (LAAC) safely and effectively prevent thromboembolic and bleeding events in NVAF patients with a history of PCI compared to those without PCI?
Cohort (n=109)
Yes
Does left atrial appendage closure (LAAC) safely and effectively prevent thromboembolic and bleeding events in NVAF patients with a history of PCI compared to those without PCI?
Answers are grounded in this paper and cite their sources.
LAAC is a safe and effective option for stroke prevention in NVAF patients with a history of PCI, showing comparable long-term outcomes to those without PCI and reducing expected thromboembolic and bleeding events.
Objectives: Nonvalvular atrial fibrillation (NVAF) concomitant with coronary artery disease (CAD) may increase the risk of thromboembolism. Antithrombotic therapy for NVAF patients with percutaneous coronary intervention (PCI) remains contradictory and challenging. This study aimed to assess the safety and efficacy of left atrial appendage closure (LAAC) in a cohort of patients with NVAF and PCI.Methods: 109 patients undergoing LAAC procedures between March 2017 and December 2020 were categorized into 2 groups, 36 patients with PCI (Group I) and 73 without (Group II). Peri-procedural and long-term complications as well as ischemia and bleeding events were retrospectively analyzed. Results: Group I had more diabetes mellitus (55.6% vs. 26.0%; p=0.003), a higher CHA2DS2-VASc scores (5.44±1.85 vs. 4.22±1.64; p=0.002) and HAS-BLED scores (3.39±0.93 vs. 2.74±1.05; p=0.003) compared to Group II. Procedure-related complications within 7 days were similar in both groups (8.3% vs 8.2%; P= 1.000). Over a median follow-up period of 20 months, there were no significant differences between two subgroups with regard to cardiovascular death (2.8% vs. 0%, p=0.330), stroke/transient ischemic attack (2.8% vs. 5.5%, p=1.000), major bleeding (0% vs. 2.7%, p=1.000) and device related thrombus (8.3% vs. 1.4%, p=0.104). The observed annualised thromboembolic and major bleeding events by Kaplan–Meier analysis was decreased by 82.4% and 100% in group I, 55.9% and 75.8% in group II, respectively.Conclusions: LAAC is a safe and effective option for stroke prevention in NVAF patients with PCI.
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Yu et al. (2022) conducted a cohort in Nonvalvular atrial fibrillation (n=109). Percutaneous coronary intervention vs. No percutaneous coronary intervention was evaluated on Stroke or transient ischemic attack (p=1.000). In patients with nonvalvular atrial fibrillation undergoing left atrial appendage closure, prior percutaneous coronary intervention did not alter the risk of stroke or transient ischemic attack compared to those without prior intervention.
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