Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:78

Article

Simard, Trevor¹  Jung, Richard G.²  Lehenbauer, Kyle³  Piayda, Kerstin^4,5  Pracon, Radoslaw⁶  Jackson, Gregory G.⁷  Flores-Umanzor, Eduardo⁸  Faroux, Laurent⁹  Korsholm, Kasper¹⁰  Chun, Julian K. R.¹¹  Chen, Shaojie¹¹  Maarse, Moniek^12,13  Montrella, Kristi¹⁴  Chaker, Zakeih¹⁵  Spoon, Jocelyn N.¹⁶  Pastormerlo, Luigi E.¹⁷  Meincke, Felix^18,20  Sawant, Abhishek C.¹⁹  Moldovan, Carmen M.²⁰  Qintar, Mohammed²¹  Aktas, Mehmet K.²²  Branca, Luca²³  Radinovic, Andrea²⁴  Ram, Pradhum²⁵  El-Zein, Rayan S.²⁶  Flautt, Thomas²⁷  Ding, Wern Yew³⁴  Sayegh, Bassel^29,30  Benito-Gonzalez, Tomas³¹  Lee, Oh-Hyun³²  Badejoko, Solomon O.³³  Paitazoglou, Christina³⁴  Karim, Nabeela³⁵  Zaghloul, Ahmed M.³⁶  Agrawal, Himanshu³⁷  Kaplan, Rachel M.³⁸  Alli, Oluseun³⁹  Ahmed, Aamir⁴⁰  Suradi, Hussam S.⁴⁰  Knight, Bradley P.³⁸  Alla, Venkata M.³⁷  Panaich, Sidakpal S.³⁶  Wong, Tom³⁵  Bergmann, Martin W.³⁴  Chothia, Rashaad³³  Kim, Jung-Sun³²  Perez de Prado, Armando³¹  Bazaz, Raveen²⁹  Gupta, Dhiraj²⁸  Valderrabano, Miguel²⁷  Sanchez, Carlos E.²⁶  El Chami, Mikhael F.²⁵  Mazzone, Patrizio²⁴  Adamo, Marianna²³  Ling, Fred²²  Wang, Dee Dee²¹  O'Neill, William²¹  Wojakowski, Wojtek²⁰  Pershad, Ashish¹⁹  Berti, Sergio¹⁷  Spoon, Daniel¹⁶  Kawsara, Akram¹⁵  Jabbour, George¹⁴  Boersma, Lucas V. A.^12,13  Schmidt, Boris¹¹  Nielsen-Kudsk, Jens Erik¹⁰  Rodes-Cabau, Josep⁹  Freixa, Xavier⁸  Ellis, Christopher R.⁷  Fauchier, Laurent⁴¹  Demkow, Marcin⁶  Sievert, Horst⁴  Main, Michael L.³  Hibbert, Benjamin²  Holmes, David R.¹  Alkhouli, Mohamad¹ 

[1] Mayo Clin, Sch Med, Dept Cardiovasc Dis, 200 First St SW, Rochester, MN 55905 USA

[2] Univ Ottawa, Heart Inst, Capital Res Grp, Ottawa, ON, Canada

[3] St Lukes Mid Amer Heart Inst, Div Cardiol, Kansas City, MO USA

[4] CardioVasc Ctr Frankfurt, Frankfurt, Germany

[5] Heinrich Heine Univ, Div Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany

[6] Natl Inst Cardiol, Coronary & Struct Heart Dis Dept, Warsaw, Poland

[7] Vanderbilt Heart & Vasc Inst, Nashville, TN USA

[8] Univ Barcelona, Hosp Clin Barcelona, August Pi & Sunyer Biomed Res Inst, Dept Cardiol, Barcelona, Spain

[9] Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[10] Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark

[11] Markuskrankenhaus, Cardioangiol Ctr Bethanien, Med Klin 3, Frankfurt, Germany

[12] St Antonius Hosp, Cardiol, Nieuwegein, Netherlands

[13] LB Amsterdam Univ, Med Ctr, Amsterdam, Netherlands

[14] Univ Pittsburgh, Med Ctr, Inst Heart & Vasc, Altoona, PA USA

[15] West Virginia Sch Med, Div Cardiol, Morgantown, WV 26506 USA

[16] Int Heart Inst Montana, Missoula, MT USA

[17] Fdn Toscana Gabriele Monasterio Massa, Scuola Super St Anna, Pisa, Italy

[18] Asklepios Klin St Georg, Hamburg, Germany

[19] Banner Univ, Med Ctr, Phoenix, AZ USA

[20] Med Univ Silesia, Div Cardiol & Struct Heart Dis, Katowice, Poland

[21] Henry Ford Hlth Syst, Div Cardiol, Detroit, MI USA

[22] Univ Rochester, Med Ctr, Div Cardiol, Rochester, NY 14642 USA

[23] Spedali Civili Brescia, Cardiothorac Dept, Catheterizat Lab, Brescia, Italy

[24] San Raffaele Univ Hosp, Arrhythmol Dept, Milan, Italy

[25] Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA

[26] OhioHlth Riverside Methodist Hosp, Div Cardiol, OhioHlth Doctors Hosp, Columbus, OH USA

[27] Houston Methodist Hosp, Houston, TX 77030 USA

[28] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England

[29] Univ Pittsburgh, Med Ctr, Inst Heart & Vasc, Pittsburgh, PA USA

[30] Excela Hlth, Heart Lung & Vasc Inst, Pittsburgh, PA USA

[31] Univ Hosp Leon, Dept Cardiol, Leon, Spain

[32] Yonsei Univ, Severance Cardiovasc Hosp, Div Cardiol, Coll Med, Seoul, South Korea

[33] St Josephs Med Ctr Dign Hlth, Div Internal Med, Stockton, CA USA

[34] Cardiologicum Hamburg, Hamburg, Germany

[35] Royal Brompton & Harefield Hosp, Guys & St Thomas Natl Hlth Serv Fdn Trust, London, England

[36] Univ Iowa, Dept Internal Med, Carver Coll Med, Div Cardiovasc Med, Iowa City, IA 52242 USA

[37] Creighton Univ, Sch Med, Omaha, NE 68178 USA

[38] Northwestern Univ, Bluhm Cardiovasc Inst, Chicago, IL 60611 USA

[39] Novant Hlth Heart & Vasc Inst, Div Cardiol, Charlotte, NC USA

[40] Rush Univ, Med Ctr, Chicago, IL 60612 USA

[41] Univ Tours, CHU Trousseau, Serv Cardiol, Fac Med, Tours, France

关键词: Amplatzer cardiac plug;    Amulet;    device-related thrombus;    DRT;    LAAO;    left atrial appendage occlusion;    Watchman;    Watchman FLX;    ACP;   

DOI  :  10.1016/j.jacc.2021.04.098

来源: Elsevier

【 摘 要 】

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: 1.573.69), 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. (J Am Coll Cardiol 2021;78:297-313) (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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