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LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH ATRIAL FIBRILLATION AND PREVIOUS MAJOR GASTROINTESTINAL BLEEDING: INSIGHT FROM THE AMPLATZER CARDIAC PLUG MULTICENTER REGISTRY
1139 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH ATRIAL FIBRILLATION AND PREVIOUS MAJOR GASTROINTESTINAL BLEEDING: INSIGHT FROM THE AMPLATZER CARDIAC PLUG MULTICENTER REGISTRY Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Structural Heart Interventions: Focus on Mitral Valve, Left Atrial Appendage and HOCM Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease Presentation Number: 1156-180 Authors: Mathieu Lempereur, Adel Aminian, Xavier Freixa, Sameer Gafoor, Samera Shakir, Heyder Omran, George Giannakoulas, Sergio Berti, Gennaro Santoro, Joelle Kefer, Ulf Landmesser, Jens Nielsen, Ignacio Cruz-Gonzalez, Prapa Kanagaratnam, Fabian Nietlispach, Reda Ibrahim, Horst Sievert, Wolfgang Schillinger, Jai-Wun Park, Bernhard Meier, Haralampos Karvounis, Apostolos Tzikas, University Hospital of Liège, Liège, Belgium
Background: History of major gastrointestinal (GI) bleeding represents a frequent clinical indication for left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF). This study aims to investigate the procedural safety and long-term outcome of patients with previous major GI bleeding (MGIB) undergoing LAAO. Methods: Data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients were analyzed. Patients with previous MGIB as indication for LAAO were compared to patients without previous MGIB.
Results: A total of 151 patients (14.4%) with previous MGIB were identified. Peri-procedural major bleeding events were more frequent in patients with previous MGIB (4.0% vs 0.8%, p=0.001). With an average follow-up of 1.3 years, the observed annual stroke/TIA rate and major bleeding rate for patients with prior MGIB were 2.1% (61.4% relative reduction according to the CHA2DS2-VASc score) and 5.2 % (12.1% relative reduction according to the expected rate based on the HAS-BLED score), respectively.
Conclusions: In patients with NVAF and previous MGIB, LAAO was associated with a low annual rate of stroke/TIA. Peri-procedural major bleeding events were more frequent in this specific population although the annual major bleeding rate showed a 12.1% relative risk reduction according to the HAS-BLED score.
Interventional Cardiology LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH ATRIAL FIBRILLATION AND PREVIOUS MAJOR GASTROINTESTINAL BLEEDING: INSIGHT FROM THE AMPLATZER CARDIAC PLUG MULTICENTER REGISTRY Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Structural Heart Interventions: Focus on Mitral Valve, Left Atrial Appendage and HOCM Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease Presentation Number: 1156-180 Authors: Mathieu Lempereur, Adel Aminian, Xavier Freixa, Sameer Gafoor, Samera Shakir, Heyder Omran, George Giannakoulas, Sergio Berti, Gennaro Santoro, Joelle Kefer, Ulf Landmesser, Jens Nielsen, Ignacio Cruz-Gonzalez, Prapa Kanagaratnam, Fabian Nietlispach, Reda Ibrahim, Horst Sievert, Wolfgang Schillinger, Jai-Wun Park, Bernhard Meier, Haralampos Karvounis, Apostolos Tzikas, University Hospital of Liège, Liège, Belgium
Background: History of major gastrointestinal (GI) bleeding represents a frequent clinical indication for left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF). This study aims to investigate the procedural safety and long-term outcome of patients with previous major GI bleeding (MGIB) undergoing LAAO. Methods: Data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients were analyzed. Patients with previous MGIB as indication for LAAO were compared to patients without previous MGIB.
Results: A total of 151 patients (14.4%) with previous MGIB were identified. Peri-procedural major bleeding events were more frequent in patients with previous MGIB (4.0% vs 0.8%, p=0.001). With an average follow-up of 1.3 years, the observed annual stroke/TIA rate and major bleeding rate for patients with prior MGIB were 2.1% (61.4% relative reduction according to the CHA2DS2-VASc score) and 5.2 % (12.1% relative reduction according to the expected rate based on the HAS-BLED score), respectively.
Conclusions: In patients with NVAF and previous MGIB, LAAO was associated with a low annual rate of stroke/TIA. Peri-procedural major bleeding events were more frequent in this specific population although the annual major bleeding rate showed a 12.1% relative risk reduction according to the HAS-BLED score.