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. 2023 Nov 2;25(11):euad315.
doi: 10.1093/europace/euad315.

Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion

Domenico G Della Rocca  1   2 , Michele Magnocavallo  1   3 , Christoffel J Van Niekerk  4 , Thomas Gilhofer  5 , Grace Ha  6 , Gabriele D'Ambrosio  7 , Sanghamitra Mohanty  1 , Carola Gianni  1 , Jennifer Galvin  6 , Giampaolo Vetta  2 , Carlo Lavalle  8 , Luigi Di Biase  1   9 , Antonio Sorgente  2 , Gian-Battista Chierchia  2 , Carlo de Asmundis  2 , Lukas Urbanek  10 , Boris Schmidt  10 , J Christoph Geller  7   11 , Dhanunjaya R Lakkireddy  12 , Moussa Mansour  6 , Jacqueline Saw  5 , Rodney P Horton  1 , Douglas Gibson  4 , Andrea Natale  1   4   13
Affiliations

Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion

Domenico G Della Rocca et al. Europace. .

Abstract

Aims: Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO).

Methods and results: A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively.

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.

Keywords: Atrial fibrillation; Chronic kidney disease; Left atrial appendage; Stroke; Watchman.

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Conflict of interest statement

Conflict of interest: G.B.C. received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Boston Scientific, and Acutus Medical. C.dA. received research grants on behalf of the centre from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus and compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Livanova, Boston Scientific, Atricure, Acutus Medical, and Daiichi Sankyo. J.C.G. is a consultant and has received speaker fees from Boston Scientific, Abbott, Medtronic, Biotronik, Pfizer, Bayer, Novartis, Daiichi Sankyo, and Boehringer Ingelheim. M.M. serves as a consultant for Boston Scientific and Abbott. L.D.B. is a consultant for Stereotaxis, Biosense Webster, Boston Scientific, Rhythm Management, and Abbott Medical. J.S. is a consultant for Boston Scientific, Abbott, Baylis, Gore, and FEops, and a proctor for Boston Scientific and Abbott. D.G. is a consultant for Boston Scientific, Abbot, Acutus, and Biosense Webster. A.N. is as a consultant for Abbott, Biosense Webster, Inc., Biotronik, Boston Scientific, Baylis, and Medtronic. The remaining authors have nothing to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Primary composite endpoint. Cumulative incidence function for the primary endpoint of CV mortality, stroke, TIA, peripheral TE events, major bleeding. CKD, chronic kidney disease; CV, cardiovascular; TE, thrombo-embolic; TIA, transient ischaemic attack.
Figure 2
Figure 2
Secondary endpoints. Kaplan–Meier survival curves for A) CV mortality, B) TE events, C) stroke/TIA, and D) major bleeding. CKD, chronic kidney disease; CV, cardiovascular; TIA, transient ischaemic attack.
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Comment in

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