Arrhythmias & electrophysiologyCohort study
Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion
- Observational cohort study
- consecutive patients
Authors' conclusion
Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
Study context
- Population
- Consecutive atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO)
- Participants
- 2,124 patients · 2,226 patient-years
- Exposure
- Chronic kidney disease (CKD) stage 3, 4 and 5 vs CKD stage 1+2
- CKD stage 1+2n = 1,089reference
- CKD stage 3n = 796
- CKD stage 4n = 170
- CKD stage 5n = 69
- Outcome
- Cardiovascular (CV) mortality, TE and major bleeding
- Follow-up
- Mean 13 ± 7 months
Main finding
As reported in the abstract
Primary endpoint incidence
- CKD stage 3 vs CKD stage 1+2: P = 0.04
- CKD stage 4 vs CKD stage 1+2: P = 0.01
- CKD stage 5 vs CKD stage 1+2: P = 0.001
Observational data: associations, not effects.
Further findings
Thrombo-embolism (TE) risk reduction with LAAO vs expected (CHA2DS2-VASc), by CKD group
- TE RR, CKD stage 1+2, 3, 4 and 5 respectively
- 72, 66, 62, and 41%
- expected annual TE risk estimated from CHA2DS2-VASc
Major bleeding relative RR with LAAO vs expected (HAS-BLED), by CKD group
- Major bleeding relative RR, CKD stage 1+2, 3, 4 and 5 respectively
- 58, 44, 51, and 52%
- expected annual major bleeding risk estimated from HAS-BLED
Safety
Major peri-procedural adverse events, by worsening CKD
- Non-significant higher incidence with worsening CKD (stage 1+2 vs 3 vs 4 vs 5)
- 1.7 vs. 2.3 vs. 4.1 vs. 4.3
- P
- P = 0.14
Original publication
Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion. Europace. Published 27 October 2023. doi:10.1093/europace/euad315
Summarised from the published abstract; every number is checked against it