Effect of Glomerular Filtration Rates on Outcomes Following Percutaneous Left Atrial Appendage Closure

Am J Cardiol. 2021 Apr 15;145:77-84. doi: 10.1016/j.amjcard.2020.12.081. Epub 2021 Jan 27.

Abstract

Scarce data support the prescription of oral anticoagulation in patients with concomitant advanced chronic kidney disease (CKD) and atrial fibrillation, and left atrial appendage closure (LAAC) may provide a favorable risk-benefit ratio in this population. However, outcomes of LAAC in CKD patients are unknown. We aimed to investigate the impact of moderate-to-severe CKD on clinical outcomes following percutaneous LAAC. This was a multicenter study including 1094 patients who underwent LAAC. Moderate-to-severe CKD was defined as an eGFR<45 mL/min. Death, ischemic stroke, severe bleeding (≥BARC 3a) and serious adverse event (SAE; composite of death, stroke or severe bleeding) were recorded. A total of 300 patients (27.4%) had moderate-to-severe CKD. There were no differences between groups in periprocedural complications or device related thrombosis. At a median follow-up of 2 (1 to 3) years, patients with moderate-to-severe CKD did not present an increased risk of ischemic stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.22 to 1.92; p = 0.435) but were at a higher risk of death (HR: 2.84; 95% CI: 2.22 to 3.64; p <0.001), severe bleeding (HR: 1.96; 95% CI: 1.36 to 2.81; p <0.001) and SAE (HR: 2.23; 95% CI: 1.80 to 2.77; p <0.001). By multivariable analysis, an eGFR<45 ml/min (HR: 1.92; 95% CI: 1.34 to 2.76; p <0.001) and previous bleeding (HR: 2.30; 95% CI: 1.27 to 4.17; p = 0.006) were associated with an increased risk of severe bleeding. In conclusion, patients with moderate-to-severe CKD who underwent LAAC had very high thrombotic and bleeding risks. Although the rates of device related thrombosis or ischemic stroke after-LAAC were not influenced by kidney dysfunction, patients with moderate-to-severe CKD remained at higher risk of severe bleeding events.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use
  • Atrial Appendage / surgery*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / surgery*
  • Cardiac Surgical Procedures
  • Cardiac Tamponade / epidemiology
  • Comorbidity
  • Embolism / etiology
  • Embolism / prevention & control
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Ischemic Attack, Transient / etiology
  • Ischemic Attack, Transient / prevention & control
  • Ischemic Stroke / etiology
  • Ischemic Stroke / prevention & control*
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy
  • Male
  • Platelet Aggregation Inhibitors / therapeutic use
  • Postoperative Complications / epidemiology
  • Postoperative Hemorrhage / epidemiology
  • Renal Dialysis
  • Renal Insufficiency, Chronic / epidemiology*
  • Severity of Illness Index
  • Stroke / epidemiology

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors