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Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion
- Source :
- Journal of the American College of Cardiology, Journal of the American College of Cardiology, 2021, 78 (4), pp.297-313. ⟨10.1016/j.jacc.2021.04.098⟩, Journal of the American College of Cardiology, 78(4), 297-313. Elsevier USA, Simard, T, Jung, R G, Lehenbauer, K, Piayda, K, Pracoń, R, Jackson, G G, Flores-Umanzor, E, Faroux, L, Korsholm, K, Chun, J K R, Chen, S, Maarse, M, Montrella, K, Chaker, Z, Spoon, J N, Pastormerlo, L E, Meincke, F, Sawant, A C, Moldovan, C M, Qintar, M, Aktas, M K, Branca, L, Radinovic, A, Ram, P, El-Zein, R S, Flautt, T, Ding, W Y, Sayegh, B, Benito-González, T, Lee, O H, Badejoko, S O, Paitazoglou, C, Karim, N, Zaghloul, A M, Agrawal, H, Kaplan, R M, Alli, O, Ahmed, A, Suradi, H S, Knight, B P, Alla, V M, Panaich, S S, Wong, T, Bergmann, M W, Chothia, R, Kim, J S, Pérez de Prado, A, Bazaz, R, Gupta, D, Valderrabano, M, Sanchez, C E, El Chami, M F, Mazzone, P, Adamo, M, Ling, F, Wang, D D, O'Neill, W, Wojakowski, W, Pershad, A, Berti, S, Spoon, D, Kawsara, A, Jabbour, G, Boersma, L V A, Schmidt, B, Nielsen-Kudsk, J E, Rodés-Cabau, J, Freixa, X, Ellis, C R, Fauchier, L, Demkow, M, Sievert, H, Main, M L, Hibbert, B, Holmes, D R & Alkhouli, M 2021, ' Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion ', Journal of the American College of Cardiology, vol. 78, no. 4, pp. 297-313 . https://doi.org/10.1016/j.jacc.2021.04.098
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
- Subjects :
- Male
Cardiac Catheterization
Time Factors
Percutaneous
left atrial appendage occlusion
Septal Occluder Device
medicine.medical_treatment
Transesophageal
[SHS]Humanities and Social Sciences
Pulmonary vein
Postoperative Complications
Risk Factors
Interquartile range
Atrial Fibrillation
Registries
Embolization
ComputingMilieux_MISCELLANEOUS
Watchman
Incidence
Atrial fibrillation
Europe
Survival Rate
Treatment Outcome
Echocardiography
Cardiology
Female
Watchman FLX
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Heart Diseases
ACP
Amplatzer cardiac plug
Amulet
DRT
LAAO
device-related thrombus
Aged
Atrial Appendage
Echocardiography, Transesophageal
Follow-Up Studies
Humans
Thrombosis
Left atrial appendage occlusion
Internal medicine
medicine
Risk factor
Thrombus
business.industry
medicine.disease
business
Subjects
Details
- ISSN :
- 07351097 and 15583597
- Volume :
- 78
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....467d31ce452f2b45bbc18e0bfd67de3e